Facilitated PCI in Patients with ST-Elevation Myocardial Infarction

Ellis, Stephen G.; Tendera, Michał; Belder, Mark de; Boven, Ad J. van; Widimský, Petr; Janssens, Luc; Andersen, Henning; Betriu, Amadeo; Savonitto, Stefano; Adamus, J; Peruga, Jan Z.; Kośmider, Maciej; Katz, O; Neunteufl, Thomas; Jorgova, J.; Dorobanțu, Maria; Grinfeld, Liliana; Armstrong, Paul W.; Brodie, Bruce R.; Herrmann, Howard C.; Montalescot, Gilles; Neumann, Franz‐Josef; Effron, Mark B.; Barnathan, Elliot S.; Topol, Eric J.

doi:10.1056/nejmoa0706816

Cited by 604 publications

(362 citation statements)

References 42 publications

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“…We also find a trend that patients in the prouk-PCI group had a less chance to have clinical composite end points (including rehospitalization, reinfarction and target vessel revascularization) at 1 year. Although there were 3 nonfatal major bleeding events in the prouk-PCI group, 2 of them occurred after 30 days, which should not be considered to be related to fibrinolysis by prouk.Previous studies had shown that facilitated PCI was associated with increased rates in early thrombotic complications or bleeding and had not demonstrated clinical benefits over primary PCI alone [5,6]. It is noted that this study is different from those studies in following two points.…”

mentioning

confidence: 59%

The Efficacy and Safety of Pharmacoinvasive Therapy with Prourokinase for Acute ST‐Segment Elevation Myocardial Infarction Patients with Expected Long Percutaneous Coronary Intervention‐Related Delay

Han

Liu

Jing

et al. 2013

Cardiovascular Therapeutics

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SUMMARYObjectives: To elucidate the efficacy and safety of pharmacoinvasive therapy by using prourokinase (prouk) in patients with ST-segment elevation myocardial infarction (STEMI). Background: Patients with STEMI often have long percutaneous coronary intervention (PCI)-related delays due to various reasons, which are associated with poor outcomes. Methods: A randomized study which enrolled patients from four centers in China was conducted. Patients were randomly assigned to accept routine primary PCI or prouk-PCI. The primary end points were the angiographic parameters, including thrombolysis in myocardial infarction (TIMI) flow grade, TIMI frame count, and myocardial blush grade. Secondary endpoints were incidence of major adverse cardiac events (MACE, defined as death from all causes, reinfarction, revascularization, or rehospitalization due to new or worsening congestive heart failure) at 30 days and 1 year. Results: One hundred and ninety-seven eligible patients were enrolled, of whom 100 were randomized to the prouk-PCI group. Significantly more patients in the prouk-PCI group than in the PCI group had an opened infarct-related artery on arrival in the catheterization laboratory (48% vs. 21%, P = 0.0002) and better TIMI frame count after PCI (33 AE 6 vs. 40 AE 10, P < 0.001). At 1-year follow-up, there was a trend that patients in the prouk-PCI group had less chances to have MACE (7.0% vs. 12.6%, P = 0.235) or be readmitted to hospital due to new or worsening congestive heart failure (1.0% vs. 4.1%, P = 0.209). Conclusion: A strategy of emergent PCI preceded by fibrinolysis with prouk results in a better myocardial perfusion in infarct-related artery compared with primary PCI alone in patients with STEMI and long PCI-related delay.Primary percutaneous coronary intervention (PCI) is an effective treatment for ST-segment elevation myocardial infarction (STEMI) when it can be performed rapidly [1]. However, this procedure may not completely prevent further myocardial damage due to reperfusion injury and distal embolization [2]. More importantly, even in the hospital with primary PCI capability, patients with STEMI often have long PCI-related delays due to various reasons, which are associated with poorer outcomes [3]. In those patients, the appropriate and timely use of reperfusion therapy is likely more important than the choice of reperfusion methods. Indeed, American College of Cardiology/American Heart Association (ACC/AHA) guidelines recognize that one reperfusion approach is not superior for all patients, in all clinical settings, at all times of day [4]. The use of facilitated PCI was shown to be detrimental compared with primary PCI, with increased ischemic and bleeding events, and a trend toward excess mortality [5,6]. Conversely, among high-risk STEMI patients, the treatment with fibrinolysis and transferred for PCI within 6 h after fibrinolysis was associated with significantly fewer ischemic complications than that in standard treatment [7]. Tissue plasminogen activator (t-PA) is the commonly use...

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confidence: 59%

The Efficacy and Safety of Pharmacoinvasive Therapy with Prourokinase for Acute ST‐Segment Elevation Myocardial Infarction Patients with Expected Long Percutaneous Coronary Intervention‐Related Delay

Han

Liu

Jing

et al. 2013

Cardiovascular Therapeutics

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“…253,254 Antithrombotic treatment in DM patients undergoing coronary revascularization for stable angina or ACS is no different from those without DM. [255][256][257] Initial trials in glycoprotein IIb/IIIa inhibitors reported an interaction with DM, but this was not confirmed in the recent Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT 2) trial. 258 Prasugrel is superior to clopidogrel in reducing the composite endpoint of cardiovascular death or MI or stroke without excess major bleeding.…”

Section: Specific Aspects Of Percutaneous and Surgical Revascularizatmentioning

confidence: 99%

ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD – Summary

diabetes

Rydén

Grant

et al. 2014

Diabetes and Vascular Disease Research

175

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“…Der Begriff "facilitated PCI" wird benutzt, um eine PCI unmittelbar nach Fibrinolyse zu beschreiben, der Begriff " pharmakoinvasive Strategie" bezieht sich auf eine PCI, die 3−24 h nach Fibrinolyse vorgenommen wird, und der Begriff Rescue-PCI ist definiert als eine PCI, die wegen Lyseversagen durchgeführt wird, nachgewiesen durch eine STSegment-Resolution von weniger als 50 % 60-90 min nach Abschluss der Fibrinolyse-Therapie. [148][149][150][151][152].…”

Section: Die Kombination Von Fibrinolyse Und Perkutaner Koronarintervunclassified

Das initiale Management des akuten Koronarsyndroms

Νικολάου

Arntz

Bellou

et al. 2015

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Facilitated PCI in Patients with ST-Elevation Myocardial Infarction

Cited by 604 publications

References 42 publications

The Efficacy and Safety of Pharmacoinvasive Therapy with Prourokinase for Acute ST‐Segment Elevation Myocardial Infarction Patients with Expected Long Percutaneous Coronary Intervention‐Related Delay

The Efficacy and Safety of Pharmacoinvasive Therapy with Prourokinase for Acute ST‐Segment Elevation Myocardial Infarction Patients with Expected Long Percutaneous Coronary Intervention‐Related Delay

ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD – Summary

Das initiale Management des akuten Koronarsyndroms

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