Benefit of Early Invasive Therapy in Acute Coronary Syndromes

Bavry, Anthony A.; Kumbhani, Dharam J.; Rassi, Andrew N.; Bhatt, Deepak L.; Askari, Arman T.

doi:10.1016/j.jacc.2006.06.050

Cited by 465 publications

(57 citation statements)

References 37 publications

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“…In the current study the possibility of differentiated impact of treatment on prognosis has been eliminated because all patients underwent an early invasive treatment that has been proved to improve survival in patients with STEMI [18], NSTEMI [13, 14] and unstable angina [4]. Moreover, the recently reported reductions in the 6-month rates of new heart failure and mortality in patients with ACS may be attributed, at least in part, to the progressive increase in the use of primary PCI in these patients [19].…”

Section: Discussionmentioning

confidence: 99%

“…Of note, although it is well known that information obtained by angiography bears important prognostic information [8,9,10,11,12], in these registries coronary angiography was performed only in a proportion (usually selected) of patients. Several studies have demonstrated that invasive therapy reduces mortality in patients with non-ST-segment elevation ACS compared with conservative therapy [13, 14]; however, marked differences in applying invasive therapy among patients with STEMI and non-ST-segment elevation myocardial infarction (NSTEMI) have been reported [4, 6]. Moreover, crossovers from one form of therapy to the other (predominantly from noninvasive to invasive therapy) occurred so often that a comparison of therapeutic approaches is almost impossible [15].…”

Section: Introductionmentioning

confidence: 99%

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Patterns of Presentation and Outcomes of Patients with Acute Coronary Syndromes

et al. 2009

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Objectives: We undertook this study to assess the relationship between presentation pattern and mortality in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention. Methods: This registry included 10,455 patients with ACS, of whom 2,853 patients had ST-segment elevation myocardial infarction(STEMI), 3,060 patients had non-ST-segment elevation myocardial infarction (NSTEMI) and 4,542 patients had unstable angina. The primary outcome was 1-year mortality. Results: At 1 year there were 976 deaths, 390 (13.7%) among STEMI patients, 366 (12.0%) among NSTEMI patients and 220 (4.8%) among patients with unstable angina (OR = 1.17, 95% CI 1.01–1.35 for STEMI vs. NSTEMI; OR = 3.00, 95% CI 2.56–3.51 for STEMI vs. unstable angina, and OR = 2.58, 95% CI 2.20–3.04 for NSTEMI vs. unstable angina). In the Cox proportional hazards model ACS form was an independent correlate of 1-year mortality (HR = 0.90, 95% CI 0.73–1.13 for STEMI vs. NSTEMI; HR = 1.56, 95% CI 1.13–2.14 for STEMI vs. unstable angina; HR = 1.72, 95% CI 1.30–2.29 for NSTEMI vs. unstable angina). Conclusions: The presentation pattern affects 1-year mortality in patients with ACS, with unadjusted mortality being highest in patients with STEMI and lowest in patients with unstable angina.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patterns of Presentation and Outcomes of Patients with Acute Coronary Syndromes

et al. 2009

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“…Выявлено значительное увеличение числа неблагоприятных исходов -как фатальных (19,7 против 7,4 %; р<0,001), так и несмертельных (50,8 против 23,8 %, р<0,001) среди пациентов с КИН. В группе пациентов с КИН как при поступлении, так и к окончанию госпитального периода медианы концентрации NGAL составили 1,9 [1,4] нг / мл и 3,4 [2,6] нг / мл соответственно и были значимо выше, чем у пациентов без признаков КИН (1,28 [0,3-1,9] и 1,61 [1,36] нг / мл). Наличие хронической болезни почек (ХБП) в анамнезе в 1,7 раза увеличивало риск развития КИН (p=0,013), снижение СКФ менее 60 мл / мин / 1,73 м 2 при поступлении в стационар -в 3,7 раза (p=0,039), уровень NGAL ≥1,33 нг / мл, определенный на 1-е сут-ки после РКВ, увеличивал риск ее выявления в 5,5 раза (p=0,041).…”

Section: резюмеunclassified

“…Materials and methods. The study included 954 patients with ОРИГИНАЛЬНЫЕ СТАТЬИ § И спользование ранней инвазивной стратегии лече-ния у пациентов с ИМ в общей популяции снижает риск постинфарктных осложнений и летальных исходов на 30-60 % [1], и оно особенно рекомендовано в груп-пах высокого риска [2]. Однако уже на этапе диагности-ческой коронароангиографии (КАГ), по данным ряда авторов, в 2-29,7 % случаев развивается острое почечное повреждение (ОПП), индуцированное введением рент-геноконтрастного средства (РКС) -контраст-индуциро-ванная нефропатия (КИН) [3].…”

Section: резюмеunclassified

Contrast-induced nephropathy in patients with myocardial infarction who had undergone interventions using radiocontrast agents: A diagnostic role of serum NGAL

Каретникова¹,

Kalaeva²,

Евсеева³

et al. 2017

RHJ

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“…Among patients receiving fibrinolytic therapy, strong evidence has emerged that optimal outcomes are achieved by routine immediate or early catheterization and PCI thereafter. Urgent diagnostic cardiac catheterization with subsequent intervention as appropriate also is recommended for patients presenting with non-STEMI, 142,143 those with a nondiagnostic ECG, or patients presenting 12 to 48 hours after symptom onset. 52 This increasing emphasis on routine PCI in patients with acute coronary syndromes regardless of whether fibrinolytic therapy is administered can best be met by establishing "interventional centers of excellence" with ambulance diagnosis of AMI 144 and subsequent selective routing, 59 similar to the trauma center model, which will further reduce mortality by requiring optimized critical pathways to reduce door-to-balloon times, greater operator and institutional volumes, and careful quality control with internal and external feedback.…”

Section: Conclusion: Interventional Strategies In Stemimentioning

confidence: 99%

Angioplasty Strategies in ST-Segment–Elevation Myocardial Infarction

Stone

2008

Circulation

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A s reviewed in part I of this report, 1 primary PCI without antecedent fibrinolytic therapy has become widely accepted as the preferred reperfusion modality for patients with ST-segment-elevation myocardial infarction (STEMI) presenting at suitably equipped tertiary facilities. However, primary percutaneous coronary intervention (PCI) is not offered at Ն50% of US hospitals, and many of those that do are unable to offer primary PCI as an around-the-clock service. Primary PCI also is less widely available in many other countries than in the United States. Thus, fibrinolytic therapy continues to be administered to many patients with STEMI. 2,3 Given the relatively low rates of successful reperfusion with fibrinolysis, 4,5 revascularization often is required afterward, the indications for and outcomes of which are critically evaluated here. The impact of individual operator and institutional volumes on PCI outcomes is reviewed. Evidencebased recommendations for selecting among the various reperfusion therapy options are then offered for the patients with STEMI presenting at centers with and without interventional capabilities, with distinctions drawn where the evidence-based recommendations in this article differ substantially from recently updated task force guidelines of the American College of Cardiology (ACC) and American Heart Association (AHA). 5 Finally, recent and ongoing investigations to further improve outcomes after catheter-based reperfusion therapy are summarized. Angioplasty After Fibrinolytic TherapyPCI after fibrinolytic therapy in STEMI may be performed in a variety of settings: (1) rescue PCI after failed fibrinolysis in patients with ongoing symptoms, myocardial injury, or persistent coronary occlusion, typically initiated within 60 to 120 minutes after fibrinolytic administration; (2) immediate PCI (also known as facilitated PCI), performed within several hours after fibrinolytic administration, regardless of whether clinical or ECG evidence of ongoing myocardial injury is present; (3) delayed routine PCI, in which patients who are stable for several days after fibrinolytic administration undergo angiography and PCI, regardless of the presence or absence of ischemia or myocardial viability; and (4) delayed selective angioplasty, in which only patients with spontaneous or inducible ischemia after fibrinolysis undergo catheterization and PCI when appropriate.Similar to primary PCI, each of these interventional strategies describes an approach of angiography followed by triage to angioplasty, coronary artery bypass graft surgery, or medical therapy, a decision based on the coronary anatomy, left ventricular function, and other patient-related factors. However, PCI is performed in Ϸ80% to 90% of angiographically screened patients requiring revascularization. Rescue PCIRescue PCI refers to the strategy of urgent catheterization after fibrinolytic therapy has clinically failed to restore reperfusion of the infarct artery. Patients in whom fibrinolysis fails to restore patency of the infarct-related a...

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Benefit of Early Invasive Therapy in Acute Coronary Syndromes

Abstract: Managing non-ST-segment elevation acute coronary syndromes by early invasive therapy improves long-term survival and reduces late myocardial infarction and rehospitalization for unstable angina.

Cited by 465 publications

References 37 publications

Patterns of Presentation and Outcomes of Patients with Acute Coronary Syndromes

Patterns of Presentation and Outcomes of Patients with Acute Coronary Syndromes

Contrast-induced nephropathy in patients with myocardial infarction who had undergone interventions using radiocontrast agents: A diagnostic role of serum NGAL

Angioplasty Strategies in ST-Segment–Elevation Myocardial Infarction

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