Aborted myocardial infarction in ST-elevation myocardial infarction: insights from the STrategic Reperfusion Early After Myocardial infarction trial

Maleki, Neda Dianati; Werf, Frans Van de; Goldstein, Patrick; Adgey, Jennifer; Lambert, Yves; Sulimov, V. A.; Rosell-Ortiz, Fernando; Gershlick, Anthony; Zheng, Yinggan; Westerhout, Cynthia M.; Armstrong, Paul W.

doi:10.1136/heartjnl-2014-306023

Cited by 17 publications

(11 citation statements)

References 17 publications

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“…It is possible that despite lower incidence of CS in the setting of STEMI, increasing prevalence of above mentioned conditions is contributing to maintaining the overall incidence of CS. Interestingly, in the randomized STREM trial (STrategic Reperfusion Early After Myocardial infarction trial) [24], using early thrombolytic therapy within 3 hours has led to earlier resolution of ST elevation with lower incident of adverse outcome in patients with aborted MI. This suggests that time to perfusion is one of the most important parameter to improve outcome in STEMI patients.…”

Section: Discussionmentioning

confidence: 98%

Age adjusted nationwide trends in the incidence of all cause and ST elevation myocardial infarction associated cardiogenic shock based on gender and race in the United States

Movahed

Khan

Hashemzadeh

2015

Cardiovascular Revascularization Medicine

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Section: Discussionmentioning

confidence: 98%

Age adjusted nationwide trends in the incidence of all cause and ST elevation myocardial infarction associated cardiogenic shock based on gender and race in the United States

Movahed

Khan

Hashemzadeh

2015

Cardiovascular Revascularization Medicine

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“…The composite primary end point of death, shock, congestive heart failure, or reinfarction (not death or reinfarction) at 30 days was 12.4% in the fibrinolytic group and 14.3% in the primary PCI group (relative risk, 0.86; 95% confidence interval, 0.68-1.09; P=0.21). The earlier administration of fibrinolytic therapy was associated with lower rates of cardiogenic shock and congestive heart failure, more aborted myocardial infarction, 18 and higher patency rates on the initial coronary angiogram, but there were no differences in death or reinfarction rates. Nonintracranial bleeding and ICH after a protocol amendment were higher with fibrinolytic therapy, but not statistically different.…”

Section: Article See P 1139mentioning

confidence: 86%

Evolution From Fibrinolytic Therapy to a Fibrinolytic Strategy for Patients With ST-Segment–Elevation Myocardial Infarction

Bates

2014

Circulation

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P lacebo-controlled trials with fibrinolytic agents first demonstrated important reductions in morbidity and mortality when reperfusion therapy was administered to patients with ST-segment-elevation myocardial infarction (STEMI). 1,2 Although primary percutaneous coronary intervention (PCI) is a better reperfusion strategy when compared with fibrinolytic therapy in randomized clinical trials, 3 geographic access and logistical delays in time-to-treatment may decrease some of the benefits of primary PCI in clinical practice. 4 Patients in the comparative trials were selected for randomization, delays to primary PCI were short, differences between treatments were magnified by the inclusion of studies with streptokinase, bleeding and intracerebral hemorrhage (ICH) rates with fibrinolysis may have been increased by higher anticoagulation targets than are now used, and reinfarction rates after fibrinolysis may have been higher than in the current era where clopidogrel and enoxaparin have shown benefit. 5-7 Most importantly, fibrinolytic therapy was tested as monotherapy, with crossover to rescue PCI or the early invasive strategy discouraged by most protocols. In contrast, national registry reports including a broader spectrum of patients, time delays, interventional cardiologists, and hospitals have shown no difference in mortality rates between primary PCI and fibrinolytic therapy coupled with early coronary angiography. 8,9 Thus, the fibrinolytic strategy that includes timely coronary angiography, and is now recommended by practice guidelines, is different from the fibrinolytic therapy that was tested years ago against placebo or primary PCI. 10,11Article see p 1139The best current fibrinolytic strategy may include the combination of bolus tenecteplase, 12 aspirin, 2 clopidogrel, 5,6 and enoxaparin 7 as initial therapy. Clopidogrel is recommended because prasugrel and ticagrelor have not been tested with fibrinolytic therapy. These agents facilitate prehospital treatment 13 and improve outcomes in patients with STEMI compared with historical in-hospital fibrinolytic therapy. 1 Importantly, included in the fibrinolytic strategy is emergent coronary angiography for reperfusion failure 14 and coronary angiography within 24 hours after successful reperfusion. 15This fibrinolytic strategy was recently tested against primary PCI in the Strategic Reperfusion Early after Myocardial Infarction (STREAM) trial that included 1892 patients with STEMI. 16,17 It is important to note that these patients were a select group that differed from routine reperfusion candidates. They presented within 3 hours of symptom onset (not 6 or 12 hours), were unable to undergo primary PCI within 1 hour of first medical contact (not 2 hours), had at least 2 mm of ST-elevation on their qualifying ECG (not 1 mm), and were given prehospital (not in-hospital) tenecteplase. The median time from symptom onset to start of reperfusion therapy was only 100 minutes in the fibrinolytic group versus 178 minutes in the primary PCI group, so more patients in ...

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“…6 We will attempt to analyze the data from the DIOCLES registry in this respect, but the relatively small size of the population, especially in the subgroup with STEMI, will probably make it impossible to draw firm conclusions. In this subgroup, the overall management strategy applied is almost certainly more relevant than the technological level of the treatment hospital.…”

Section: Diocles: Algunos Matices Y Nuevas Preguntas Respuestamentioning

confidence: 99%

DIOCLES: Some Caveats and New Questions. Response

Barrabés

Bardajı́

2015

Revista Española de Cardiología (English Edition)

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Aborted myocardial infarction in ST-elevation myocardial infarction: insights from the STrategic Reperfusion Early After Myocardial infarction trial

Abstract: A PI strategy of early fibrinolysis more frequently aborts MI than primary PCI. Such PI patients had more favourable outcomes as compared with non-AbMIs. Diligent review of ECG evolution in STEMI distinguishes AbMI from infarct masquerade. ClinicalTrials.gov ID: NCT00623623.

Cited by 17 publications

References 17 publications

Age adjusted nationwide trends in the incidence of all cause and ST elevation myocardial infarction associated cardiogenic shock based on gender and race in the United States

Age adjusted nationwide trends in the incidence of all cause and ST elevation myocardial infarction associated cardiogenic shock based on gender and race in the United States

Evolution From Fibrinolytic Therapy to a Fibrinolytic Strategy for Patients With ST-Segment–Elevation Myocardial Infarction

DIOCLES: Some Caveats and New Questions. Response

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