Prospective evaluation of eligibility for thrombolytic therapy in acute myocardial infarction

French, John K.; Williams, Barbara F.; Hart, Hamish; Wyatt, Susan; Poole, Jon; Ingram, Christine; Ellis, Christopher J.; Williams, Miles; White, Harvey D.

doi:10.1136/bmj.312.7047.1637

Cited by 89 publications

(31 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Differences in the time-dependence efficacy of various reperfusion regimens [3][4][5][6][7] and the fact that a sizable number of patients with AMI present relatively late after symptom onset 15,16 underscore the clinical importance of such stratification strategy. Experimental studies in dogs 17 and clinical studies in patients with AMI 18 have demonstrated the existence of residual blood flow to the infarcted area.…”

Section: Discussionmentioning

confidence: 99%

Therapy-Dependent Influence of Time-to-Treatment Interval on Myocardial Salvage in Patients With Acute Myocardial Infarction Treated With Coronary Artery Stenting or Thrombolysis

et al. 2003

View full text Add to dashboard Cite

Background-The relationship between myocardial salvage and time-to-treatment interval in patients with acute myocardial infarction (AMI) treated with coronary artery stenting or thrombolysis has not been studied. Methods and Results-This study analyzed 264 patients with AMI randomized to coronary stenting (133 patients) or thrombolysis (131 patients) in the setting of 2 randomized trials. Patients were divided into the following 3 groups defined by tertiles of the time-to-treatment interval: lower tertile (Ͻ165 minutes), middle tertile (165 to 280 minutes), and upper tertile (Ͼ280 minutes). Paired scintigraphic examinations were performed to obtain salvage index, which was the primary end point of the study. In the group with thrombolysis, the salvage index (median

show abstract

Section: Discussionmentioning

confidence: 99%

Therapy-Dependent Influence of Time-to-Treatment Interval on Myocardial Salvage in Patients With Acute Myocardial Infarction Treated With Coronary Artery Stenting or Thrombolysis

et al. 2003

View full text Add to dashboard Cite

show abstract

“…32 Thirty-three percent of the patients had ST-segment depression, paced rhythms, or T-wave inversion, and 14% presented after 12 hours.…”

Section: Eligibilitymentioning

confidence: 99%

Thrombolysis for Acute Myocardial Infarction

1998

View full text Add to dashboard Cite

Thrombolytic therapy has been a major advance in the management of acute myocardial infarction. Unfortunately, it continues to be underused or is administered later than is optimal. Thrombolytic therapy works by lysing infarct artery thrombi and achieving reperfusion, thereby reducing infarct size, preserving left ventricular function, and improving survival. The most effective thrombolytic regimens achieve angiographic epicardial infarct-artery patency in only approximately 50% of patients within 90 minutes. Bleeding requiring transfusion occurs in approximately 5% of patients and stroke in approximately 1.8% with these regimens, which include adjunctive aspirin and intravenous heparin. There are several ways in which reperfusion rates and thus patient outcomes might be improved, such as different dosing regimens of established agents; combinations of different agents; improved adjunctive therapy such as direct antithrombin agents, low-molecular-weight heparin, or glycoprotein IIb/IIIa receptor antagonists; or the development of novel thrombolytic agents with enhanced fibrin specificity, resistance to native inhibitors, or prolonged half-lives allowing bolus administration. All of these strategies are being tested in clinical trials. The best approach currently is to administer thrombolytic therapy as soon as possible to all patients without contraindications who present within 12 hours of symptom onset and have ST-segment elevation on the ECG or new-onset left bundle-branch block, unless an alternative reperfusion strategy is planned.

show abstract

“…Although the life-saving role of thrombolysis as the most widely used option for reperfusion is well established, 35 many patients are not eligible for thrombolysis, 17 and these patients are at particularly high risk. 36 Therefore, the interventional strategy applied among patients who did not meet conventional eligibility criteria for thrombolysis may have contributed to the reduction of the excess risk carried by women. In addition, the large use of glycoprotein IIb/IIIa inhibition has probably had a positive impact on the results of our study.…”

Section: Commentmentioning

confidence: 99%

Sex-Based Analysis of Outcome in Patients With Acute Myocardial Infarction Treated Predominantly With Percutaneous Coronary Intervention

Mehilli

Kastrati²,

Dirschinger³

et al. 2002

JAMA

144

View full text Add to dashboard Cite

Prospective evaluation of eligibility for thrombolytic therapy in acute myocardial infarction

Cited by 89 publications

References 22 publications

Therapy-Dependent Influence of Time-to-Treatment Interval on Myocardial Salvage in Patients With Acute Myocardial Infarction Treated With Coronary Artery Stenting or Thrombolysis

Therapy-Dependent Influence of Time-to-Treatment Interval on Myocardial Salvage in Patients With Acute Myocardial Infarction Treated With Coronary Artery Stenting or Thrombolysis

Thrombolysis for Acute Myocardial Infarction

Sex-Based Analysis of Outcome in Patients With Acute Myocardial Infarction Treated Predominantly With Percutaneous Coronary Intervention

Contact Info

Product

Resources

About