Facilitated PCI by combination fibrinolysis or upstream tirofiban in acute ST-segment elevation myocardial infarction: Results of the Alteplase and Tirofiban in Acute Myocardial Infarction (ATAMI) trial

Peters, Stefan; Truemmel, Martina; Koehler, Brigitte

doi:10.1016/j.ijcard.2007.08.048

Cited by 12 publications

(5 citation statements)

References 39 publications

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Section: Discussioncontrasting

confidence: 78%

“…Our study is consistent with previous trials of facilitated PCI that significantly improved TIMI flow of the IRA after thrombolysis. 8,10,20,21 However, our results contradict few studies on infarct size, which has been advocated as an end point in reperfusion trials due to its potential prognostic value. 22 Thiele et al 23 found that early administration of reteplase plus abciximab does not lead to a reduction of infarct size compared with abciximab alone in patients with acute myocardial infarction referred for PCI.…”

Section: Discussioncontrasting

confidence: 63%

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Single Bolus r-SAK Before Primary PCI for ST-Segment–Elevation Myocardial Infarction

Chen,

Eikelboom,

Tan

et al. 2024

Circ: Cardiovascular Interventions

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BACKGROUND: It is uncertain whether adjunctive thrombolysis is beneficial for patients with ST-segment–elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) within 120 minutes of presentation. This study was to determine whether in patients presenting with ST-segment–elevation myocardial infarction a single bolus recombinant staphylokinase (r-SAK) before timely PCI leads to improved patency of the infarct-related artery and reduces the infarct size. METHODS: This is an open-label, prospective, multicenter, randomized study. We enrolled patients aged 18 to 75 years who were within 12 hours of symptom onset of ST-segment–elevation myocardial infarction and expected to undergo PCI within 120 minutes. Patients were administered loading doses of aspirin and ticagrelor and intravenous heparin and were randomized to receive 5 mg bolus of r-SAK or normal saline intravenously before PCI. The primary end point was Thrombolysis in Myocardial Infarction flow grade 2 to 3 or grade 3 in the infarct-related artery 60 minutes after thrombolysis. The infarct size was detected by cardiac magnetic resonance 5 days after randomization. The safety end point was major bleeding (Bleeding Academic Research Consortium ≥3) during 30-day follow-up. RESULTS: A total of 283 patients were screened from 8 centers and 200 were randomized (median age, 58.5 years; 14% female). The median symptom to thrombolysis time was 252.5 (interquartile range, 142.8–423.8) minutes and thrombolysis to coronary arteriography was 50.0 (interquartile range, 37.0–66.0) minutes. Patients randomized to r-SAK compared with normal saline more often had Thrombolysis in Myocardial Infarction flow grade 2 to 3 (69.0% versus 29.0%; P <0.001) and Thrombolysis in Myocardial Infarction flow grade 3 (51.0% versus 18.0%; P <0.001) and had smaller infarct size (21.91±10.84% versus 26.85±12.37%; P =0.016). There was no increase in major bleeding (r-SAK, 1.0% versus control, 3.0%; P =0.616). CONCLUSIONS: A single bolus r-SAK before primary PCI for ST-segment–elevation myocardial infarction improves infarct-related artery patency and reduces infarct size without increasing major bleeding. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05023681.

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Section: Discussioncontrasting

confidence: 78%

Section: Discussioncontrasting

confidence: 63%

Single Bolus r-SAK Before Primary PCI for ST-Segment–Elevation Myocardial Infarction

Chen,

Eikelboom,

Tan

et al. 2024

Circ: Cardiovascular Interventions

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“…Se trataba precisamente de facilitar la angioplastia mediante un fármaco que redujera la carga trombótica. A tal efecto, se exploraron inhibidores de la glicoproteina IIb/IIIa [73][74][75][76][77] , fibrinolíticos [78][79][80][81] , o una asociación de ambos [82][83][84] . Globalmente estos estudios, no arrojaron resultados favorables.…”

Section: Desarrollo De Redes De Atención Al Iamunclassified

Impacto en la mortalidad tras la implantación de una red de atención al infarto agudo de miocardio con elevación del segmento ST. Estudio IPHENAMIC

Aldama

López

Santás

et al. 2020

Revista Española de Cardiología

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“…This strategy may be appealing particularly when long‐distance transportation to cath lab is needed. Few small trials have been so far conducted comparing combination therapy versus upstream GP IIb‐IIIa inhibitors alone for PCI [131–134], showing no benefits in terms of myocardial salvage [131] and clinical outcome, despite the significantly improved preprocedural epicardial recanalization. Data from the FINESSE trial [116] showed that, despite improvement in preprocedural TIMI flow, combotherapy did not confer any benefit in terms of survival, but was associated with higher risk of major bleeding complications (4.8% vs. 2.6%, P = 0.025).…”

Section: Clinical Datamentioning

confidence: 99%

Glycoprotein IIb‐IIIa Inhibitors

Luca

2011

Cardiovascular Therapeutics

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SUMMARYPlatelets play a pivotal role in the pathogenesis of coronary artery disease and myocardial infarction. Therefore, great interests have been focused in the last decades on improvement in antiplatelet therapies, that currently are regarded as main pillars in the prevention and treatment of coronary artery disease, with special attention to glycoprotein IIb-IIIa (GP IIb-IIIa) receptors, that mediates the final stage of platelet activation. GP IIb-IIIa inhibitors, especially abciximab, have been shown to improve clinical outcome in patients undergoing primary angioplasty for STEMI. Upstream administration cannot routinely recommended, but may potentially be considered among high-risk patients within the first 4 h from symptoms onset. In case of periprocedural administration of antithrombotic therapy, Bivalirudin should be considered, especially in patients at high risk for bleeding complications. Among high-risk patients with acute coronary syndromes, an early invasive strategy with selective downstream administration of GP IIb-IIIa inhibitors is the strategy of choice, whereas bivalirudin should be considered in patients at high risk for bleeding complications. Among patients with unstable angina GP IIb-IIIa inhibitors should be considered only in case of evidence of intracoronary thrombus or in case of thrombotic complications (as provisional use). Further, randomized trials are certainly needed in the era of new oral antiplatelet therapies, and with strategies to prevent bleeding complications such as larger use of radial approach, mechanical closure devices, bivalirudin, or postprocedural protamine administration to promote early sheat removal.

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Facilitated PCI by combination fibrinolysis or upstream tirofiban in acute ST-segment elevation myocardial infarction: Results of the Alteplase and Tirofiban in Acute Myocardial Infarction (ATAMI) trial

Cited by 12 publications

References 39 publications

Single Bolus r-SAK Before Primary PCI for ST-Segment–Elevation Myocardial Infarction

Single Bolus r-SAK Before Primary PCI for ST-Segment–Elevation Myocardial Infarction

Impacto en la mortalidad tras la implantación de una red de atención al infarto agudo de miocardio con elevación del segmento ST. Estudio IPHENAMIC

Glycoprotein IIb‐IIIa Inhibitors

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