Fibrinolysis or Primary PCI in ST-Segment Elevation Myocardial Infarction

Armstrong, Paul W.; Gershlick, Anthony; Goldstein, Patrick; Wilcox, Robert G.; Danays, Thierry; Lambert, Yves; Sulimov, V. A.; Rosell-Ortiz, Fernando; Ostojić, Miodrag; Welsh, Robert C.; Carvalho, Antônio Carlos; Nanas, John N.; Arntz, Hans-Richard; Halvorsen, Sigrun; Huber, Kurt; Grajek, Stefan; Fresco, Claudio; Bluhmki, Erich; Regelin, Anne; Vandenberghe, Katleen; Bogaerts, Kris; Werf, Frans Van de

doi:10.1056/nejmoa1301092

Cited by 643 publications

(574 citation statements)

References 15 publications

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“…At that time, patients successfully treated with thrombolytic therapy did not regularly undergo CAG [29]. However, in today’s studies on pharmacological-invasive strategies, in example the STREAM study, no significant difference between pre-hospital thrombolytic therapy and primary PCI has been observed, in patients with limited symptom duration [30]. Due to significant distances and only one PCI centre, most patients cannot undergo primary PCI in our region.…”

Section: Discussionmentioning

confidence: 99%

Treatment of acute myocardial infarction in the sub-arctic region of Norway. Do we offer an equal quality of care?

Norum

Hovland

Balteskard

et al. 2017

International Journal of Circumpolar Health

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Patients, relatives, healthcare workers and administrators are concerned about the quality of care offered. We aimed to explore the treatment of acute myocatrdial infarction (AMI) in Northern Norway, compare it with the national figures, and document whether there is an equal quality of care or not. The retrospective study included data on patients' treatment for AMI. The following sources were employed. The Norwegian Patient Registry, National Quality of Care Database, Norwegian Myocardial Infarction Registry and data from the National Air Ambulance Services of Norway. The period 2012-2014/15 was studied and the variables were: incidence of AMI, gender and age adjusted rates of AMI and revascularization (PCI, CABG) based on patient's place of living (according to hospital catchment area) and 30-day survival rate. The annual incidence of AMI was 9% higher in the northern region. Significant incidence variations (2.7–5.9 AMI/1000 inhabitants) between the hospitals' catchment areas were revealed. The 30-day survival rate varied between 85.1–92.1% between hospitals. The variation in revascularization/AMI rate was 0.72–1.54. Air amublance services' availability varied through the day. In conclusion, significant variations in the AMI rate and an unequal service within the region was revealed.

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Section: Discussionmentioning

confidence: 99%

Treatment of acute myocardial infarction in the sub-arctic region of Norway. Do we offer an equal quality of care?

Norum

Hovland

Balteskard

et al. 2017

International Journal of Circumpolar Health

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“…Та-ким образом, удалось создать сплошной характер вы-борки и избежать систематической ошибки отбора. В соответствии с инструкцией по применению доза те-нектеплазы определялась в зависимости от веса па-циента, но у больных в возрасте 75 лет и старше, со-гласно измененному протоколу исследования STREAM и рекомендациям по реваскуляризации ESC, умень-шалась вдвое [9,10]. Назначение сопутствующей те-рапии (антитромбоцитарные препараты, нефракцио-нированный гепарин, статины, бета-адреноблокаторы и др.)…”

Section: материал и методыunclassified

Comparative Results of Recombinant Non-Immunogenic Staphylokinase and Tenecteplase Use in St-Segment Elevation Myocardial Infarction in Real Clinical Practice

Мазур

Рабинович²,

Мазур

et al. 2017

Racionalʹnaâ farmakoterapiâ v kardiologii

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Цель. Изучить результаты применения рекомбинантной неиммуногенной стафилокиназы и тенектеплазы у пациентов с инфарктом миокар-да с подъемом сегмента ST (ИМпST) при фармакоинвазивном подходе в условиях реальной клинической практики. Материал и методы. В неэкспериментальное исследование со смешанным дизайном включено 84 больных ИМпST с давностью симптомов до 12 ч. Основная группа -38 пациентов, которым проведена тромболитическая терапия (ТЛТ) препаратом рекомбинантной неиммуноген-ной стафилокиназы по зарегистрированной госпитальной схеме. Группа сравнения -46 пациентов, получивших ТЛТ тенектеплазой, в т.ч. с дву-кратным снижением дозы в группе старше 75 лет. Оценивалась динамика сегмента ST на ЭКГ, ангиографические критерии реперфузии, кли-нические исходы -летальность, реинфаркт, инсульт, кровотечения и аллергические реакции. Результаты. Снижение сегмента ST на 70% через 180 мин было достигнуто у 66% и 61% больных (p=0,66), а антеградный коронарный кро-воток по инфаркт-связанной артерии TIMI II-III -у 61% и 67% больных (p=0,63) в группах рекомбинантной неиммуногенной стафилокина-зы и тенектеплазы, соответственно. По частоте летальных исходов, геморрагического и ишемического инсульта, кардиогенного шока, разви-тию аневризмы и тромбоза полости левого желудочка группы не различались. Массивных кровотечений и аллергических реакций не было за-регистрировано. Заключение. В реальной клинической практике рекомбинантная неиммуногенная стафилокиназа сопоставима с тенектеплазой по эффективности, безопасности и влиянию на развитие осложнений и исходы ИМпST.Ключевые слова: инфаркт миокарда, тромболизис, коронарный кровоток, рекомбинантная неиммуногенная стафилокиназа, тенектеплаза. Aim. To compare the efficacy and safety of thrombolytic therapy with recombinant non-immunogenic staphylokinase and tenecteplase in ST elevation myocardial infarction (STEMI) in real clinical practice. Material and methods. 84 patients with onset of STEMI symptoms up to 12 hours ago were included into the non-experimental study with mixed design. Recombinant non-immunogenic staphylokinase and tenecteplase were used in 38 and 46 patients, respectively. The dynamics of the ST segment on the ECG, angiographic reperfusion criteria were evaluated as well as clinical outcomes -mortality, reinfarction, stroke, bleeding and allergic reactions. Results. The ST-segment resolution by 70% after 180 min was achieved in 66% and 66% of patients in recombinant non-immunogenic staphylokinase group and in tenecteplase group, respectively (p=0.66) as well as antegrade coronary blood flow through the infarct-related artery TIMI II-III in 61% and 67% of patients, respectively (p=0.63). Mortality and the rate of reinfarction, intracranial bleeding, stroke, cardiogenic shock, left ventricle aneurism and thrombosis were similar in both groups. Large bleeding (otherwise intracranial one) and allergic reactions were not registered. Conclusion. In real clinical practice the efficacy and safety of recombinant non-immunogenic staphylokinase and tenecteplase in STEMI are similar.

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“…Usually primary PCI is the gold standard and most preferred reperfusion intervention if performed within 90 to 120 minutes of symptom onset as shown by various trials and meta-analysis [8] [13]- [15]. But in cases where PCI cannot be performed within the critical time or there is lack of access to PCI capable hospital or contraindication to PCI, fibrinolysis is the modality of reperfusion [8] [15] [16] (Figure 3).…”

Section: Pathophysiology and Management Of Stemimentioning

confidence: 99%

PCI in Post Thrombolysis Stable STEMI Patients: A Timeline in Question

Hasan¹,

Rashid²,

Bhuiyan³

2015

WJCD

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ST elevation myocardial infarction (STEMI) occupies a significant portion of the cardiovascular disease spectrum and poses a continuing challenge on the health care delivery system worldwide. A dilemma exists in the clinical triage system for appropriate strategic modalities of treatment, based on underlying triad of patient-hospital-cardiac pathological factors as well as cut off timelines. Current European Society of Cardiology (ESC) guideline recommends percutaneous coronary intervention (PCI) within 3 to 24 hours in post thrombolysis stable patients. This review critically evaluated the evidences underlying the ESC recommendation. Trials included in this review are SIAM III, GRACIA 1, CAPITAL-AMI, CARESS-IN-AMI, NORDISTEMI, PRAGUE-1, WEST and LEIPZIG. Most of the evidences support the notion for immediate post thrombolysis PCI in stable patients within 1.9 to 2.7 hours, which contradicts the ESC timeline of up to 24 hours. Also, there is a reduced generalizability of the trial results due to differences in the design of the various trials, study population, composite endpoints, variations in drug dose & formulation, co-administration of pharmacotherapies and type of stents used. This warrants further research for standardization & optimization of the treatment protocol with respect to post thrombolysis PCI in stable STEMI patients.

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Fibrinolysis or Primary PCI in ST-Segment Elevation Myocardial Infarction

Cited by 643 publications

References 15 publications

Treatment of acute myocardial infarction in the sub-arctic region of Norway. Do we offer an equal quality of care?

Treatment of acute myocardial infarction in the sub-arctic region of Norway. Do we offer an equal quality of care?

Comparative Results of Recombinant Non-Immunogenic Staphylokinase and Tenecteplase Use in St-Segment Elevation Myocardial Infarction in Real Clinical Practice

PCI in Post Thrombolysis Stable STEMI Patients: A Timeline in Question

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