Percutaneous coronary intervention and 1 year survival in patients treated with fibrinolytic therapy for acute ST-elevation myocardial infarction

McClelland, Anthony; Owens, Colum; Walsh, Simon; McCarty, David; Mathew, Thomas; Stevenson, Mike; Gracey, Helen; Khan, Mazhar M.; Adgey, A. A. J.

doi:10.1093/eurheartj/ehi149

Cited by 12 publications

(9 citation statements)

References 19 publications

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“…The outcomes were in keeping with studies in which thrombolysis was followed by frequent revascularization [2, 23,37,38,39,40,41] and suggest that the advantage of PPCI may be attenuated in this setting. The findings are especially relevant for the large number of centers where immediate angiography-intervention facilities are not always available or readily applicable [28].…”

Section: Discussionsupporting

confidence: 80%

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Thrombolysis Followed by Early Revascularization: An Effective Reperfusion Strategy in Real World Patients with ST-Elevation Myocardial Infarction

Jaffe

Halon²,

Karkabi³

et al. 2007

Cardiology

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Background: Several trials suggested superiority of primary percutaneous coronary intervention (PPCI) angioplasty over thrombolysis in patients with ST-elevation myocardial infarction (STEMI), but many trials were characterized by low rates of early revascularization in patients treated with initial thrombolysis. We tested the hypothesis that in patients with hemodynamically stable STEMI, initial thrombolysis followed by an active early rescue/definitive revascularization strategy could achieve salutary short- and long-term outcomes. Methods: A prospective registry documented all 212 STEMI patients who received initial thrombolytic therapy over a 2-year period in a single medical center. Median patient age was 58 (range: 29–92) years, 47 (22%) patients were aged >70 years and 18 (8%) >80 years. Fifty-two (25%) patients underwent rescue angioplasty <6 h after thrombolysis for inadequate clinical reperfusion. In 194/212 (92%) patients, coronary angiography was performed during initial hospitalization, PCI in 168 (79%), and coronary bypass surgery in 18 (8%). Results: Thirty-day mortality was 4.7% and 1-year mortality 6.7%. Mortality was not related to diabetes mellitus, hypertension, anterior infarction location, fibrin-specific thrombolytic drug or rescue PCI. By multivariate analysis, in-hospital definitive angiography/revascularization (p < 0.0001) and TIMI risk score >3 on admission (p < 0.01) were significant independent predictors of both 30 day and 12 month outcome. Conclusions: Initial thrombolysis was useful and effective in real-world STEMI patients when coupled with an aggressive policy of rescue angioplasty and early in-hospital revascularization. Outcomes compared favorably with those reported for PPCI trials. The adverse prognosis in older patients with higher TIMI risk score suggests that in those patients alternative initial treatment strategies such as PPCI should be considered.

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Section: Discussionsupporting

confidence: 80%

“…McClelland et al [41] reported improved survival in thrombolytic patients who underwent in-hospital coronary revascularization. These data support the current practice of frequent referral of STEMI patients for revascularization [42, 43] as amplified in current PCI guidelines [44].…”

Section: Discussionmentioning

confidence: 99%

Thrombolysis Followed by Early Revascularization: An Effective Reperfusion Strategy in Real World Patients with ST-Elevation Myocardial Infarction

Jaffe

Halon²,

Karkabi³

et al. 2007

Cardiology

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“…In this study, we assessed changes in the surface expression of CD11b and CD62L (L-selectin) adhesion molecules on neutrophils and monocytes from peripheral blood, before and 60 min after stent deployment in order to identify early cellular markers that characterize the leukocyte activation after PCI, in patients with previous STEMI first treated with fibrinolytic agents [8]. Additionally, to illustrate multiple aspects of this inflammatory reaction, simultaneous measurements of high-sensitive C-reactive protein (hsCRP) and other plasma cytokines were also performed.…”

Section: Introductionmentioning

confidence: 99%

Leukocyte activation after coronary stenting in patients during the subacute phase of a previous ST-elevation myocardial infarction

Stakos

Kotsianidis

Tziakas

et al. 2007

Coronary Artery Disease

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“…Unfortunately, the transfer strategy of these studies cannot be replicated in general practice. Randomized clinical trials defining invasive care for the stable post-thrombolytic patient reported conflicting results [26][27][28][29][30][31]. The recent ASSENT-4 PCI study showed that mechanical reperfusion was not improved when patients were given full dose fibrinolysis before primary PCI.…”

Section: Discussionmentioning

confidence: 99%

Is delayed facilitated percutaneous coronary intervention better than immediate in reperfused myocardial infarction? Six months follow up findings

Pasquale

Cannizzaro

Parrinello

et al. 2006

J Thromb Thrombolysis

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Our data suggest the safety and possible use of delayed facilitated PCI in patients with STEMI, and that delayed PCI in patients treated with combined lytic and IIb/IIIa inhibitors appears to be as effective and possibly superior (reduced ischemic events and repeat PCI) as immediate PCI. The patients in this study were successfully reperfused, with TIMI-3 flow and our data may not apply to patients with TIMI 0-2 flow. This strategy could allow transferring the reperfused patients and performing PCI after hours < 72 hours and not immediately, thereby reducing the number of urgent PCI and costs, obtaining similar results, but mostly causing less discomfort to the patient. Our results had to be interpreted with caution, because current guidelines do not recommend the combined therapy, but suggest further studies. The study was aimed to investigate the outcomes in patients initially successfully treated pharmacologically and immediate PCI < 2 h, and in patients initially successfully treated with pharmacological therapy and delayed PCI (12-72 h). All patients had to have successful reperfusion, to receive the combination of a standard abciximab or tirofiban infusion plus half dose rtPA. Similar results were observed in both groups. Delayed PCI group showed a significant lower incidence in restenosis (0.01), minor bleedings (0.005), ischemic events (0.01) and a reduced angiographic evidence of thrombus formation in IRA (0.001). Our data suggest the safety and possible use of delayed facilitated PCI in patients with STEMI. Our results had to be interpreted with caution, because current guidelines do not recommend the combined therapy, but suggest further studies.

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Percutaneous coronary intervention and 1 year survival in patients treated with fibrinolytic therapy for acute ST-elevation myocardial infarction

Abstract: In-hospital PCI in patients treated with fibrinolytic therapy for STEMI is associated with a substantial reduction in 1 year mortality.

Cited by 12 publications

References 19 publications

Thrombolysis Followed by Early Revascularization: An Effective Reperfusion Strategy in Real World Patients with ST-Elevation Myocardial Infarction

Thrombolysis Followed by Early Revascularization: An Effective Reperfusion Strategy in Real World Patients with ST-Elevation Myocardial Infarction

Leukocyte activation after coronary stenting in patients during the subacute phase of a previous ST-elevation myocardial infarction

Is delayed facilitated percutaneous coronary intervention better than immediate in reperfused myocardial infarction? Six months follow up findings

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