Comparison of Long-Term Prognostic Evaluation Between Pre-Intervention Thrombolysis and Primary Coronary Intervention: A Prospective Randomized Trial

Itoh, Tomonori; Fukami, Kenichi; Suzuki, Tomomi; Kimura, Takeshi; Kanaya, Yoshinori; Orii, Makoto; Goto, Iwao; Matsui, Hiroki; Sugawara, Shoma; Nakajima, Shigeru; Fusazaki, Tetsuya; Nakamura, Motoyuki

doi:10.1253/circj.cj-10-74-0904

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…Low mortality both in hospital and in the long term might have been possibly due to successful primary PCIs in our study. 26 Our second study found significantly higher plasma AVP levels in the hyponatremic patients, a finding similar to that in CHF. It is well known that non-osmotic release of AVP is closely linked to reduced effective circulating blood volume in CHF.…”

Section: Discussionsupporting

confidence: 78%

Early Development of Hyponatremia Implicates Short- and Long-Term Outcomes in ST-Elevation Acute Myocardial Infarction

Tada

Nakamura

Funayama

et al. 2011

Circ J

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Background: Clinical importance of hyponatremia in ST-elevation acute myocardial infarction (STEMI) in the era of primary intervention has not been fully understood. The aim of this study was to investigate the impact of hyponatremia on outcomes in patients with STEMI and secondarily to investigate the contribution of arginine vasopressin (AVP) to hyponatremia in STEMI. Methods and Results:Hyponatremia was defined as a sodium concentration <136 mmol/L at 72 h after hospitalization. First, the short-term (in-hospital mortality or congestive heart failure (CHF)) and long-term prognosis (cardiac death, re-admission for CHF) in STEMI patients was conducted. Second, the relationship between serum sodium level and plasma AVP was investigated. In hyponatremic patients the incidence of in-hospital heart failure was significantly greater (P=0.0018), long-term cardiac death was a higher trend (17.2% vs. 6.3%, P=0.19) and re-admission due to CHF was significantly more frequent (20.7% vs. 4.5%, P=0.0024). Plasma AVP level was higher in the hyponatremia group (4.5 vs. 2.7 pg/ml, P=0.003), and it had a negative correlation with serum sodium level (r=-0.28, P=0.02). Conclusions:Hyponatremia was frequently found in the early phase of STEMI, and associated with heart failure in both short- and long-term outcomes. Non-osmotic secretion of AVP could be involved in hyponatremia in STEMI patients. (Circ J 2011; 75: 1927 - 1933

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Section: Discussionsupporting

confidence: 78%

Early Development of Hyponatremia Implicates Short- and Long-Term Outcomes in ST-Elevation Acute Myocardial Infarction

Tada

Nakamura

Funayama

et al. 2011

Circ J

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“…The studies did, however, identify harm from intracranial hemorrhage [70][71][72] or major bleeding [70][71][72][73][74] when fibrinolytic administration is combined with immediate PCI versus immediate PCI alone.…”

Section: Evidence Summarymentioning

confidence: 99%

Part 9: Acute Coronary Syndromes

O’Connor¹,

Ali²,

Brady³

et al. 2015

Circulation

104

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“…6, 7 In this issue of the Journal, Itoh et al reported results of the IMPORTANT study, which is a prospective multicenter clinical randomized trial comparing efficacy of pre-intervention thrombolysis and primary PCI in patients with STEMI in rural areas in Japan. 8 Primary endpoints of this study were patency rate at initial angiography and left ventricular ejection fraction (LVEF) at 6 months after the onset of STEMI. Patients with risks for bleeding were carefully excluded by study design.…”

Section: Article P 1625mentioning

confidence: 99%

Do We Facilitate Facilitated Percutaneous Coronary Intervention and Pre-Intervention Thrombolysis?

Nakatani

Sato

2010

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp everal well designed clinical randomized control trials showed that compared with thrombolysis, percutaneous coronary intervention (PCI) was the superior reperfusion strategy for reducing death, reinfarction, and stroke in patients with ST-segment elevation myocardial infarction (STEMI). 1,2 Thus, PCI has been widely used as a reperfusion therapy at hospitals that have the capability of PCI in clinical practice settings. However, these trials were conducted at high volume hospitals with skilled physicians. 1,2 In addition, the number of capable hospitals to perform PCI is not necessarily high, especially in rural areas in Japan, as well as in other foreign countries. Therefore, the focus for the reperfusion strategy in acute phase has been shifted toward how we treat the patients transferred to hospitals that do not have PCI facilities or that have PCI facilities but longer door-to-balloon time required (more than 90 min). Article p 1625Recently, facilitated PCI, which is defined as planned PCI immediately after administration of thrombolitic agents, glycoprotein IIb/IIIa inhibitors, or both, has been proposed in these conditions. The facilitated PCI is considered to be a therapy, bridging the time delay between admission and initial balloon inflation time. Several clinical randomized control trials examining efficacy of that strategy on outcomes as compared with primary PCI have been conducted under various conditions. 3,4 Theoretically, the potential benefits of this strategy are thought to be reduced time to reperfusion, smaller infarct size, improved patient stability, less artery thrombus burden in the culprit lesion, greater procedural successful rate with less number of devices during procedure, preserved left ventricular function and subsequent improved survival. As expected, the patency rate defined as Thrombolysis In Myocardial Infarction grade flow at initial angiography was significantly better in the facilitated PCI group as compared with the primary PCI group. 5 However, unexpectedly facilitated PCI was significantly associated with higher mortality rate derived from a meta-analysis comparing the efficacy between facilitated and primary PCI. 5 However, in Japan, there is little evidence regarding the efficacy and safety of pre-intervention thrombolysis in STEMI patients. 6,7 In this issue of the Journal, Itoh et al reported results of the IMPORTANT study, which is a prospective multicenter clinical randomized trial comparing efficacy of pre-intervention thrombolysis and primary PCI in patients with STEMI in rural areas in Japan. 8 Primary endpoints of this study were patency rate at initial angiography and left ventricular ejection fraction (LVEF) at 6 months after the onset of STEMI. Patients with risks for bleeding were carefully excluded by study design. Secondary endpoint included major adverse cardiac events (MACE) for 5 years, which were defined as a composite of sudden death, cardiac death, non-...

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Comparison of Long-Term Prognostic Evaluation Between Pre-Intervention Thrombolysis and Primary Coronary Intervention: A Prospective Randomized Trial

Cited by 5 publications

References 23 publications

Early Development of Hyponatremia Implicates Short- and Long-Term Outcomes in ST-Elevation Acute Myocardial Infarction

Early Development of Hyponatremia Implicates Short- and Long-Term Outcomes in ST-Elevation Acute Myocardial Infarction

Part 9: Acute Coronary Syndromes

Do We Facilitate Facilitated Percutaneous Coronary Intervention and Pre-Intervention Thrombolysis?

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