Pharmacoinvasive Therapy

Antman, Elliott M.; Werf, Frans Van de

doi:10.1161/01.cir.0000128736.57259.48

Cited by 41 publications

(9 citation statements)

References 88 publications

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“…1 Among patients who present within 2 to 3 hours from onset of symptoms and when door-to-balloon time Ͻ90 minutes cannot be reliably achieved, a pharmacoinvasive approach of fibrinolysis followed by rescue PCI or routine elective PCI (at 24 to 48 hours after fibrinolysis) has been proposed. 23 The Which Early ST-Elevation Myocardial Infarction Therapy (WEST) study found that 30-day mortality was 4% with fibrinolysis and usual care versus 1% with fibrinolysis and a pharmacoinvasive approach. 5 Indeed, the timing of routine elective PCI after fibrinolytic therapy has important relevance to subsequent risk of mortality and bleeding.…”

Section: Reperfusion Strategy At Hospitals Without Pci Capabilitymentioning

confidence: 99%

Regional Systems of Care to Optimize Timeliness of Reperfusion Therapy for ST-Elevation Myocardial Infarction

et al. 2007

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Background-Quality improvement efforts have focused on strategies to improve the timeliness of reperfusion therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize the timeliness of reperfusion therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. Methods and Results-The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006. The Mayo Clinic ST-elevation myocardial infarction protocol implemented strategies to improve timeliness of reperfusion therapy and to coordinate systems of care for transfer between hospitals. The study sample consisted of 258 patients who presented to Saint Marys Hospital and were treated with primary PCI (group A), 105 patients who presented to a regional hospital with symptom onset Ͼ3 hours and then were transferred for primary PCI (group B), and 131 patients who presented to a regional hospital with symptom onset Ͻ3 hours and were treated with full-dose fibrinolytic therapy (group C). For groups A and B, median door-to-balloon times were 71 and 116 minutes, respectively. Door-to-balloon time Ͻ90 minutes was achieved in 75% of group A and 12% of group B. Median door-to-needle time was 25 minutes for group C, and 70% had door-to-needle time Ͻ30 minutes. Conclusions-The Mayo Clinic ST-elevation myocardial infarction protocol demonstrates the feasibility of implementing strategies to optimize the timeliness of reperfusion therapy and the times that can be achieved through coordinated systems of care for ST-elevation myocardial infarction patients presenting to a PCI center (Saint Marys Hospital) and 28 regional hospitals without PCI capability located up to 150 miles away across 3 states. (Circulation. 2007;116:729-736.)

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Section: Reperfusion Strategy At Hospitals Without Pci Capabilitymentioning

confidence: 99%

Regional Systems of Care to Optimize Timeliness of Reperfusion Therapy for ST-Elevation Myocardial Infarction

et al. 2007

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“…Finally, although the concept of facilitated PCI with half-dose fibrinolytic therapy appears intuitive for patients in whom a relatively prolonged transfer time is anticipated, trials that tested this strategy have been disappointing to date and suggest the potential for harm. 10 Furthermore, even though the pharmacoinvasive strategy (coronary angiography with potential PCI in all patients after successful reperfusion with full-dose fibrinolytic therapy) 11 may serve to reduce the reinfarction rate that has accounted for part of the improved outcomes of primary PCI compared with fibrinolytic therapy, 2 current evidence to support this strategy is limited.…”

Section: Articles Pp 721 and 729mentioning

confidence: 99%

Regional Systems of Care for Patients With ST-Elevation Myocardial Infarction

Jacobs

2007

Circulation

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ST-segment-elevation myocardial infarction (STEMI) presents a true medical emergency, where the relationship between treatment (reperfusion) and mortality is measured in minutes. Fortunately, when administered early in properly selected patients, both fibrinolytic therapy and primary percutaneous coronary intervention (PCI) have been associated with significant reductions in mortality. 1,2 Unfortunately, it has become increasingly clear that only a minority of STEMI patients receive fibrinolytic therapy within 30 minutes from door-to-needle or receive primary PCI within 90 minutes from door-to-balloon as recommended by the guidelines from the American College of Cardiology/American Heart Association (AHA). 3 Articles pp 721 and 729Moreover, as enthusiasm for primary PCI as the preferred reperfusion modality has escalated, the importance of time to treatment has gained increased recognition. Door-to-balloon time is now included as 1 of the core quality measures collected and reported by the Centers for Medicare and Medicaid and The Joint Commission. Furthermore, although the performance of primary PCI has increased from 18% to 53% worldwide during the past 7 years (with an expected decrease in use of fibrinolytic therapy from 50% to 28%), nearly 30% of patients still do not receive either form of therapy even in the absence of contraindications. 4 It is these realities of the current status of reperfusion therapy that have fostered the concept of systems and centers of care for STEMI patients and interest in the exploration of the feasibility of establishment of regional STEMI networks. It is not surprising that healthcare systems and hospitals across the country are examining their standards of care and organizing quality improvement initiatives to decrease time to treatment and increase adherence to evidence-based therapies for patients with STEMI. 5,6 In this issue of Circulation, 2 pioneering model regional approaches that use integrated systems of care to increase the number of STEMI patients with timely access to a PCI facility are reported.Based on the premise that primary PCI is superior to fibrinolysis even when transfer from a non-PCI-capable facility to a primary PCI center is necessary, Henry and colleagues 7 developed a PCI-based treatment system with an integrated transfer program for STEMI patients at 30 hospitals within 210 miles from the Minneapolis Heart Institute at Abbott Northwestern Hospital. Participating hospitals were divided into zone 1 (Ͻ60 miles) and zone 2 (60 to Յ210 miles) from the Minneapolis Heart Institute. A standardized treatment protocol was developed on the basis of American College of Cardiology/AHA guidelines that was identical for the PCI center, zone 1, and zone 2 hospitals except that zone 2 patients received half-dose tenecteplase (in the absence of a contraindication to fibrinolytic therapy) in anticipation of a lengthy transfer time. At each hospital, training of all personnel (emergency medical services, emergency department, primary care physicians) was performed, t...

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“…In the study conducted by Hosseinian et al (2012), unlike the findings of the present study, the educational level, age, and MI history did not have any relationship with the onset of treatment (23). In fact, given the ACC/AHA statement, the door to needle interval time should not be more than 30 minutes (24). However, the mean of the intra-hospital delay was several times more than the standard door to needle time.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Time Interval between the Onset of Clinical Symptoms and Receiving Streptokinase in Patients with Acute Myocardial Infarction (AMI) at Amir Hospital in Zabol, Iran, 2013

2017

Int. J. Adv. Res. Biol. Sci

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Myocardial infarction (MI) or acute myocardial infarction(AMI) is known as heart attack. MI occurs when blood stops flowing properly to a part of the heart. MI occurred when one of the coronary arteries develops a blockage due to an unstable buildup of with blood, cholesterol and fat. This study aimed to determine the time interval between the onset of clinical symptoms and receiving streptokinase inpatients with acute myocardial infarction (AMI) at Amir Hospital in Zabol city in 2013. This was a cross-sectional-descriptive study. In total 72 patients were selected from all patients with chest pain and who referred to the emergency of Amir Hospital during 2013 in Zabol located in southeast of Iran. All patients were diagnosed with AMI. The instrument used for data collection was a questionnaire including demographic characteristics, record of exact location of infarction, ECG, the time of patients' arrival to the emergency department (ED), and the time of receiving streptokinase. According to the obtained results of this study, the mean of onset to call, call to door, and door to needle times were 269.29±197.33, 34.02±12.32, and 96.33±49.95, respectively. The comparison of onset to call, and call to door and age, education and place of residence variables showed that there was a significant difference between these variables. In addition, the comparison of door to needle time and age, sex, education and place of residence variables showed that there was no significant difference between these variables. Delay in treatment of patients with STEM I is caused as a result of several factors including rate of patient's awareness and emergency status. We need to provide opportunities to treatment of MI by emergency and outpatient centers. To reducing in-hospital delay, we must teach physicians and emergency personnel to rapid diagnosis ofMI.

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Pharmacoinvasive Therapy

Cited by 41 publications

References 88 publications

Regional Systems of Care to Optimize Timeliness of Reperfusion Therapy for ST-Elevation Myocardial Infarction

Regional Systems of Care to Optimize Timeliness of Reperfusion Therapy for ST-Elevation Myocardial Infarction

Regional Systems of Care for Patients With ST-Elevation Myocardial Infarction

Comparison of the Time Interval between the Onset of Clinical Symptoms and Receiving Streptokinase in Patients with Acute Myocardial Infarction (AMI) at Amir Hospital in Zabol, Iran, 2013

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