Relation between flow grade after thrombolytic therapy and the effect of angioplasty on left ventricular function: A prospective randomized trial

Belenkie, Israel; Knudtson, Merril L.; Roth, David L.; Hansen, James L.; Traboulsi, Mouhieddin; Hall, Christine; Manyari, Dante E.; Filipchuck, Neil; Schnurr, Lawrence P.; Rosenal, Thomas W.; Smith, Eldon R.

doi:10.1016/0002-8703(91)90706-n

Cited by 25 publications

(8 citation statements)

References 28 publications

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“…Six randomized trials were identified for the comparison of a systematic and early catheterization versus delayed and/or ischemia-guided catheterization after fibrinolysis (n ϭ 1,508 patients) ( Table 2). Three of these trials were performed in the early days of mechanical intervention (13,28,29).…”

Section: CImentioning

confidence: 99%

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Percutaneous Coronary Intervention After Fibrinolysis

Collet¹,

Montalescot²,

May³

et al. 2006

Journal of the American College of Cardiology

113

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Section: CImentioning

confidence: 99%

“…The pharmacologic approaches were different between trials of the "balloon era" (13,28,29) and those of the "stent era" (30 -32). During the "balloon era," aspirin was not given immediately to all patients, and thienopyridines were not available.…”

Section: CImentioning

confidence: 99%

Percutaneous Coronary Intervention After Fibrinolysis

Collet¹,

Montalescot²,

May³

et al. 2006

Journal of the American College of Cardiology

113

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“…19,20 Four trials included patients with an occluded IRA (rescue PCI), 16 -18,20 whereas 2 required a patent IRA. 19,21 Balloon angioplasty success rates were generally lower when performed immediately after fibrinolysis (65% to 80%) than when performed days to weeks later (85% to 90%). Whereas several of these studies showed improved left ventricular function and/or decreased early rates of recurrent ischemia and reinfarction with immediate PCI, 17,19 others showed no benefit 18,21 or increased rates of bleeding, ischemia requiring urgent coronary artery bypass graft surgery, and mortality.…”

Section: Fibrinolysis With Versus Without Immediate Routine Pcimentioning

confidence: 99%

“…19,21 Balloon angioplasty success rates were generally lower when performed immediately after fibrinolysis (65% to 80%) than when performed days to weeks later (85% to 90%). Whereas several of these studies showed improved left ventricular function and/or decreased early rates of recurrent ischemia and reinfarction with immediate PCI, 17,19 others showed no benefit 18,21 or increased rates of bleeding, ischemia requiring urgent coronary artery bypass graft surgery, and mortality. 16,20 In contrast to these historical studies, 7 contemporary prospective, modest-sized randomized trials have been published and collectively demonstrate that routine PCI with stent implantation in the early hours after fibrinolysis may be beneficial compared with a strategy of delayed routine or ischemia-driven PCI.…”

Section: Fibrinolysis With Versus Without Immediate Routine Pcimentioning

confidence: 99%

Angioplasty Strategies in ST-Segment–Elevation Myocardial Infarction

Stone

2008

Circulation

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A s reviewed in part I of this report, 1 primary PCI without antecedent fibrinolytic therapy has become widely accepted as the preferred reperfusion modality for patients with ST-segment-elevation myocardial infarction (STEMI) presenting at suitably equipped tertiary facilities. However, primary percutaneous coronary intervention (PCI) is not offered at Ն50% of US hospitals, and many of those that do are unable to offer primary PCI as an around-the-clock service. Primary PCI also is less widely available in many other countries than in the United States. Thus, fibrinolytic therapy continues to be administered to many patients with STEMI. 2,3 Given the relatively low rates of successful reperfusion with fibrinolysis, 4,5 revascularization often is required afterward, the indications for and outcomes of which are critically evaluated here. The impact of individual operator and institutional volumes on PCI outcomes is reviewed. Evidencebased recommendations for selecting among the various reperfusion therapy options are then offered for the patients with STEMI presenting at centers with and without interventional capabilities, with distinctions drawn where the evidence-based recommendations in this article differ substantially from recently updated task force guidelines of the American College of Cardiology (ACC) and American Heart Association (AHA). 5 Finally, recent and ongoing investigations to further improve outcomes after catheter-based reperfusion therapy are summarized. Angioplasty After Fibrinolytic TherapyPCI after fibrinolytic therapy in STEMI may be performed in a variety of settings: (1) rescue PCI after failed fibrinolysis in patients with ongoing symptoms, myocardial injury, or persistent coronary occlusion, typically initiated within 60 to 120 minutes after fibrinolytic administration; (2) immediate PCI (also known as facilitated PCI), performed within several hours after fibrinolytic administration, regardless of whether clinical or ECG evidence of ongoing myocardial injury is present; (3) delayed routine PCI, in which patients who are stable for several days after fibrinolytic administration undergo angiography and PCI, regardless of the presence or absence of ischemia or myocardial viability; and (4) delayed selective angioplasty, in which only patients with spontaneous or inducible ischemia after fibrinolysis undergo catheterization and PCI when appropriate.Similar to primary PCI, each of these interventional strategies describes an approach of angiography followed by triage to angioplasty, coronary artery bypass graft surgery, or medical therapy, a decision based on the coronary anatomy, left ventricular function, and other patient-related factors. However, PCI is performed in Ϸ80% to 90% of angiographically screened patients requiring revascularization. Rescue PCIRescue PCI refers to the strategy of urgent catheterization after fibrinolytic therapy has clinically failed to restore reperfusion of the infarct artery. Patients in whom fibrinolysis fails to restore patency of the infarct-related a...

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“…O ptimal therapy during acute myocardial infarction (AMI) includes prompt re-establishment of flow in the infarct-related artery (IRA) and effective reperfusion (1)(2)(3). Early, spontaneous reperfusion occurs in a small but significant proportion of IRAs (4,5), and the majority are reperfused with thrombolytic therapy.…”

mentioning

confidence: 99%

Contrast echocardiography accurately predicts myocardial perfusion before angiography during acute myocardial infarction

Schnell

Kryski

Mann

et al. 2007

Canadian Journal of Cardiology

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O ptimal therapy during acute myocardial infarction (AMI) includes prompt re-establishment of flow in the infarct-related artery (IRA) and effective reperfusion (1-3). Early, spontaneous reperfusion occurs in a small but significant proportion of IRAs (4,5), and the majority are reperfused with thrombolytic therapy. It is difficult to determine whether patency has been achieved at a given time in most patients without cardiac catheterization. The availability of a noninvasive method to rapidly assess myocardial perfusion has important implications in the emergency management of patients presenting with a known or suspected AMI, or after administration of a thrombolytic agent. However, no technique has yet been demonstrated to quickly and reliably predict the effectiveness of reperfusion or status of the IRA.Myocardial contrast echocardiography (MCE) uses an injection of microbubbles to assess myocardial perfusion. MCE can be used to reliably assess myocardial reperfusion following primary percutaneous coronary intervention (PCI) for AMI and to predict improvement in left ventricular (LV) function, as well as to assess the degree of collateral support to the infarcted territory (6-17). However, due to time constraints and the technical demands of OBJECTIVES: To determine whether myocardial contrast echocardiography (MCE) can quickly and accurately assess myocardial perfusion and infarct-related artery (IRA) patency before emergency angiography during acute myocardial infarction (AMI). BACKGROUND: Despite encouraging experimental and clinical studies, the reliability and practicality of MCE in predicting IRA patency during AMI before angiography has not been proven. METHODS: Two-dimensional echocardiography and MCE were performed in 51 patients with AMI just before emergency angiography. With knowledge of the electrocardiogram findings and regional wall motion, myocardial perfusion was assessed to predict IRA patency. RESULTS: Myocardial perfusion studies were adequate for interpretation in 40 patients. An occluded IRA was predicted in 28 patients; the artery was occluded in 22 patients, and six patients had Thrombolysis In Myocardial Infarction (TIMI) grade 2 flow or less. A patent IRA was predicted in 12 patients; eight patients had TIMI grade 3 flow, one patient had TIMI grade 2 flow and the IRA was occluded in three patients. In one of the three patients, the appropriate view was not obtained. In another patient, collateral flow was adequate for nearnormal regional wall motion, and in the last, the findings suggested reperfusion of the proximal artery with distal embolic occlusion. Taken together, MCE accurately predicted either TIMI grade 2 flow or less, or TIMI grade 3 flow in 36 of 40 patients. Sensitivity was 87.5%, specificity and positive predictive value were 100% and negative predictive power was 66.7% (P<0.001). CONCLUSIONS: MCE, together with the electrocardiogram and regional wall motion, can be used to quickly and reliably predict IRA patency early during AMI and may be useful to facilitate a manag...

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Relation between flow grade after thrombolytic therapy and the effect of angioplasty on left ventricular function: A prospective randomized trial

Cited by 25 publications

References 28 publications

Percutaneous Coronary Intervention After Fibrinolysis

Percutaneous Coronary Intervention After Fibrinolysis

Angioplasty Strategies in ST-Segment–Elevation Myocardial Infarction

Contrast echocardiography accurately predicts myocardial perfusion before angiography during acute myocardial infarction

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