Coronary Angioplasty With or Without Stent Implantation for Acute Myocardial Infarction

Grines, Cindy L.; Cox, David A.; Stone, Gregg W.; Gracia, Eulogio; Mattos, Luiz Alberto; Giambartolomei, Alessandro; Brodie, Bruce R.; Madonna, O.; Eijgelshoven, M. H. J.; Lansky, Alexandra J.; O’Neill, William W.

doi:10.1097/00132586-200010000-00012

Cited by 81 publications

(92 citation statements)

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“…Eleven studies included patients within 12-24 hours of MI onset. Of these, four 60,61,68,69 excluded patients with cardiogenic shock.…”

Section: Adjunctive Treatmentmentioning

confidence: 99%

“…In 15 of the 32 studies, this was explicitly defined as 'major adverse cardiac events' (MACE); the remaining 17 studies did not clearly define their outcomes as MACE. Seven studies 37,38,44,60,68,73,82 included cerebrovascular events, one study 63 included recurrent ischaemia and four studies 49,56,83,84 included recurrence of angina as part of their combined event rate. The remaining seven studies did not have clearly defined combined outcomes or did not include all major adverse cardiac events.…”

Section: Outcomes Reportedmentioning

confidence: 99%

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Coronary artery stents: a rapid systematic review and economic evaluation

Hill¹,

Bagust²,

Bakhai³

et al. 2004

Health Technol Assess

144

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“…Eleven studies included patients within 12-24 hours of MI onset. Of these, four 60,61,68,69 excluded patients with cardiogenic shock.…”

Section: Adjunctive Treatmentmentioning

confidence: 99%

Section: Outcomes Reportedmentioning

confidence: 99%

Coronary artery stents: a rapid systematic review and economic evaluation

Hill¹,

Bagust²,

Bakhai³

et al. 2004

Health Technol Assess

144

View full text Add to dashboard Cite

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“…4,8,11,12 Although the existence of RI in patients undergoing percutaneous coronary intervention (PCI) in the non-AMI setting portends a poor prognosis, 13 the outcomes of primary PCI in patients with AMI and RI have not been well characterized, because such patients are typically excluded from clinical trials. 14, 15 We therefore sought to evaluate the impact of RI in a large, contemporary randomized trial of patients undergoing primary PCI for AMI.…”

mentioning

confidence: 99%

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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“…A trend toward lower rates of TIMI 3 flow was observed in the stented group with this kind of stent. 6 Newer stents were soon tried. …”

mentioning

confidence: 99%

“…A trend toward lower rates of TIMI 3 flow was observed in the stented group with this kind of stent. 6 Newer stents were soon tried. The role of adjunctive GP IIb/ IIIa use was also addressed in the newer trials, since there was already evidence that abciximab improved the efficacy of primary PTCA in the ReoPro ® And Primary PTCA Organization and Randomized Trial (RAPPORT).…”

mentioning

confidence: 99%

Reperfusion therapy for acute myocardial infarction: Drugs or devices? is this the right question?

Pavlides

Cokkinos

2004

Clinical Cardiology

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Key words: acute myocardial infarction, fibrinolysis, primary percutaneous coronary intervention Myocardial reperfusion treatment for ST-elevation acute myocardial infarction (AMI) has made great strides since the 1980s when, for the first time, its effectiveness was shown without any doubt. While the issue of pharmacologic versus mechanical reperfusion dominated the 1990s, more fundamental issues of reperfusion have emerged as the framework on which the effectiveness of any reperfusion treatment should be judged. First and foremost is the issue of complete optimal myocardial reperfusion. Its achievement appears to be surprisingly low even after the most modern reperfusion treatment, and clearly needs to be improved. 1 Thrombolysis alone reaches a plateau of 57% of normal epicardial flow (Thrombolysis in Myocardial Infarction [TIMI 3 flow]). It has been shown that of patients with TIMI 3 flow, 23% have no real myocardial perfusion; thus, patients with true myocardial reperfusion constitute 44% of the initial population. If we also count those patients with intermittent reperfusion and reocclusion, we end up with final complete, optimal myocardial reperfusion in only 25% of patients treated. Given the almost linear relationship of myocardial tissue flow with outcome, the great need for improving reperfusion therapy becomes apparent.The plateau in lowering mortality-slightly over 6% on the average in the fibrinolytic trials that have been reported so far-has been directly associated with the plateau achieved in TIMI 3 flow. The next logical step in improving the outcome of fibrinolytic therapy was an effort to improve the percentage of TIMI 3 flow by enhancing fibrinolytic therapy. 2 However, in the Global Utilization of Streptokinase and t-PA for Occluded coronary arteries-V (GUSTO V) and the Assessment of the Safety and Efficacy of a New Thrombolytic regimen-3 (ASSENT 3) trials, the combination of fibrinolytics with glycoprotein (GP) IIb/IIIa inhibitors did not lead to lower mortality. 3,4 Enhanced fibrinolysis still remains an open issue.Primary percutaneous coronary intervention (PCI) for AMI has evolved over the last 20 years in parallel to fibrinolysis. Today there are 23 randomized trials of primary PCI versus fibrinolytics, with a total of 7,739 patients enrolled.In the first-generation trials, plain balloon angioplasty was compared with fibrinolytics. In a recent meta-analysis of 11 such trials, primary percutaneous transluminal coronary angioplasty (PTCA) was better than fibrinolytics with regard to mortality (4.3 vs. 6.9%, p < 0.02), mortality/infarct recurrence (D/re-MI) (7.0 vs. 12.9%, p < 0.001), and intracranial hemorrhage (ICH) (0.07 vs. 1.08%, p < 0.001). The TIMI 3 flow achieved with primary PTCA was significantly higher than that achieved with fibrinolytics. These results held for 6 months after the acute event. 5 In the second phase, stents were introduced in an effort to decrease MI recurrence and restenosis post PTCA. In the first large stent-in AMI trial, the Stent Primary Angioplasty for My...

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Coronary Angioplasty With or Without Stent Implantation for Acute Myocardial Infarction

Cited by 81 publications

References 0 publications

Coronary artery stents: a rapid systematic review and economic evaluation

Coronary artery stents: a rapid systematic review and economic evaluation

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

Reperfusion therapy for acute myocardial infarction: Drugs or devices? is this the right question?

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