Comparison of Angioplasty with Stenting, with or without Abciximab, in Acute Myocardial Infarction

Stone, Gregg W.; Grines, Cindy L.; Cox, David A.; Garcı́a, Eulogio; Tcheng, James E.; Griffin, John J.; Guagliumi, Giulio; Stuckey, Thomas; Turco, Mark; Carroll, John D.; Rutherford, Barry D.; Lansky, Alexandra J.

doi:10.1056/nejmoa013404

Cited by 1,134 publications

(335 citation statements)

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“…We found that patients with RI were more often elderly and female, presented later, and were more likely to have a reduced left ventricular ejection fraction, all features that have been associated with increased mortality after primary PCI for AMI. 14,18,19 Patients with RI presented with more diffuse atherosclerosis, as evidenced by more frequent peripheral vascular and cerebrovascular disease and triple-vessel coronary artery disease. Patients with RI were also less likely to be discharged on ␤-blockers, which may have contributed to reduced survival.…”

Section: Discussionmentioning

confidence: 99%

“…The design and principal results of CADILLAC have been reported previously. 14 In brief, major exclusion criteria included cardiogenic shock, bleeding diathesis, and known serum creatinine (SCr) Ͼ2.0 mg/dL. However, baseline laboratories did not have to be (and frequently were not) available before patient enrollment and randomization, allowing recruitment of patients with baseline RI.…”

Section: Patient Population and Study Designmentioning

confidence: 99%

“…The primary end point was a composite of major adverse cardiovascular events (MACE), consisting of death, disabling stroke, reinfarction, or repeat targetvessel revascularization (TVR) for ischemia, as previously defined. 14 Procedural success was defined as a residual stenosis Ͻ50%, TIMI-3 flow, and absence of MACE within 7 days.…”

Section: Patient Population and Study Designmentioning

confidence: 99%

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Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

et al. 2003

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Background-The prognostic importance of renal insufficiency (RI) in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has not been well characterized. Methods and Results-PCI was performed in 2082 AMI patients without shock presenting within 12 hours of symptom onset in a prospective, multicenter randomized trial. RI was defined as a calculated (Cockroft-Gault) creatinine clearance (CrCl) Յ60 mL/min. RI at baseline was present in 18% of patients. Compared with patients without RI, patients with RI were older and were more likely to be female; to have hypertension, peripheral vascular disease, or cerebrovascular disease; and to present in heart failure. Mortality was markedly increased in patients with versus without baseline RI both at 30 days (7.5% versus 0.8%, PϽ0.0001) and at 1 year (12.7% versus 2.4%, PϽ0.0001). Mortality rates increased incrementally for every 10-mL/min decrease in baseline CrCl. By multivariate analysis, reduced baseline CrCl was a powerful independent predictor of 30-day mortality (hazard ratio, 5.77; PϽ0.0001) and remained associated with reduced survival at 1 year (hazard ratio, 1.98; Pϭ0.08). Hemorrhagic complications and transfusion requirements were also increased more than 2-fold in patients with RI, as were severe restenosis (diameter stenosis Ն70%; 20.6% versus 11.8%, Pϭ0.024) and infarct artery reocclusion (14.7% versus 7.3%, Pϭ0.02). Conclusions-Baseline RI in patients with AMI undergoing primary PCI is associated with a markedly increased risk of mortality, as well as bleeding and restenosis. Novel approaches are needed to improve the otherwise poor prognosis of patients with RI and AMI.

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Section: Discussionmentioning

confidence: 99%

Section: Patient Population and Study Designmentioning

confidence: 99%

Section: Patient Population and Study Designmentioning

confidence: 99%

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Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

et al. 2003

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“…Therefore, although a selection bias exists in the use of GPIs, it might be expected to be associated with worse clinical outcomes. The mechanism by which transient and early use of a GPI leads to reduced long-term MACE is unclear, but may relate to longterm vessel healing and stability as well as reducing the early post-PCI events associated with reduced long-term mortality (27).…”

Section: Figure 1) Kaplan-meier Curve Estimating Overall Survival Esmentioning

confidence: 99%

Late outcomes following percutaneous coronary interventions: Results from a large, observational registry

Appleby¹,

Mackie²,

Džavík³

et al. 2010

Canadian Journal of Cardiology

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T he introduction of coronary stent implantation heralded a major advance in percutaneous coronary intervention (PCI), with dramatically improved in-hospital mortality and morbidity compared with plain old balloon angioplasty for the treatment of coronary artery disease. Several randomized controlled trials (RCTs) have established the superior long-term safety and efficacy of bare-metal stenting (BMS) compared with plain old balloon angioplasty (1-3). The introduction of drug-eluting stents (DES) resulted in a further significant reduction in restenosis, and has been associated with improved procedural outcomes in a more complex subset of patients and lesions (4-7). Thus, coronary stenting using bare-metal or drug-eluting platforms has become the cornerstone of PCI, and the indications for PCI have vastly expanded beyond those originally proposed.Pooled data from randomized DES trials have shown acceptable rates of all-cause mortality, myocardial infarction (MI) and revascularization in extended follow-up, up to four years (8). Although RCTs have excellent internal validity, direct extrapolation of their findings to the general population has been problematic due to their restrictive inclusion and exclusion criteria. Early data (9,10) regarding clinical outcomes in real-world patient reports from registries had limitations in both the follow-up period and the patient cohort size; the large New York State registry (11) comparing three-year outcomes in patients undergoing coronary stenting versus coronary artery bypass graft (CABG) surgery excluded all those with previous revascularization, left main stem (LMS) disease or MI within 24 h of the index procedure (11). More recently, several registries have compared two-(6,12-14) or three-year (15) outcomes in patients undergoing BMSonly versus DES-only PCI, and confirmed higher rates of subsequent revascularization in BMS-treated patients with either lower (12-14) or equivalent (6) rates of mortality or MI in DES-treated patients, or a HeaLtH outcomes/pubLic poLicy ©2010 Pulsus Group Inc. All rights reserved BACKgRounD: Randomized controlled trials report short-and medium-term outcomes following percutaneous coronary intervention (PCI), but their applicability to the general population is not known. Data regarding the long-term clinical outcomes of patients undergoing PCI are lacking. oBJECTIVE: To determine the long-term outcomes of 'all-comers' undergoing PCI at a large-volume tertiary cardiac referral centre. METhoDs: A total of 12,662 consecutive patients undergoing an index procedure and entered into the University Health Network's (Toronto, Ontario) prospective registry between April 2000 and September 2007 were identified. In-hospital outcomes were assessed. Follow-up data were obtained through linkage to a provincial registry. Kaplan-Meier analysis was performed to calculate unadjusted survival rates, and Cox multiple regression analysis identified independent predictors of late mortality, major adverse cardiac events and all cardiovascular events. REsuLTs: T...

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“…Thirty-eight studies had fewer than 500 patients in total; two studies enrolled over 1000 patients. 45,60 Forty-one studies were multicentred. Of these, 21 were carried out in more than one country.…”

Section: Numbers Of Participants Centres and Locationsmentioning

confidence: 99%

Coronary artery stents: a rapid systematic review and economic evaluation

Hill¹,

Bagust²,

Bakhai³

et al. 2004

Health Technol Assess

143

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Comparison of Angioplasty with Stenting, with or without Abciximab, in Acute Myocardial Infarction

Abstract: At experienced centers, stent implantation (with or without abciximab therapy) should be considered the routine reperfusion strategy.

Cited by 1,134 publications

References 40 publications

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Impact of Renal Insufficiency in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction

Late outcomes following percutaneous coronary interventions: Results from a large, observational registry

Coronary artery stents: a rapid systematic review and economic evaluation

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