Relation of Clinically Defined Spontaneous Reperfusion to Outcome in ST-Elevation Myocardial Infarction

Fefer, Paul; Hod, Hanoch; Hammerman, Haim; Boyko, Valentina; Behar, Shlomo; Matetzky, Shlomi

doi:10.1016/j.amjcard.2008.08.050

Cited by 34 publications

(36 citation statements)

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“…This study adds significant data to our previously published study on this topic,7 both in its much larger sample size and in its inclusion of contemporary STE‐ACS patients treated predominantly with primary PCI. The exclusion in our current study of patients presenting in Killip class >1 is significant in that it examines exclusively a group of patients for whom no clear guideline recommendation exists regarding the timing of intervention.…”

Section: Discussionmentioning

confidence: 81%

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Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred Angiography

Fefer

Beigel

Atar

et al. 2017

JAHA

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BackgroundFew data are available regarding the optimal management of ST‐elevation myocardial infarction patients with clinically defined spontaneous reperfusion (SR). We report on the characteristics and outcomes of patients with SR in the primary percutaneous coronary intervention era, and assess whether immediate reperfusion can be deferred.Methods and ResultsData were drawn from a prospective nationwide survey, ACSIS (Acute Coronary Syndrome Israeli Survey). Definition of SR was predefined as both (1) ≥70% reduction in ST‐segment elevation on consecutive ECGs and (2) ≥70% resolution of pain. Of 2361 consecutive ST‐elevation–acute coronary syndrome patients in Killip class 1, 405 (17%) were not treated with primary reperfusion therapy because of SR. Intervention in SR patients was performed a median of 26 hours after admission. These patients were compared with the 1956 ST‐elevation myocardial infarction patients who underwent primary reperfusion with a median door‐to‐balloon of 66 minutes (interquartile range 38–106). Baseline characteristics were similar except for slightly higher incidence of renal dysfunction and prior angina pectoris in SR patients. Time from symptom onset to medical contact was significantly greater in SR patients. Patients with SR had significantly less in‐hospital heart failure (4% versus 11%) and cardiogenic shock (0% versus 2%) (P<0.01 for all). No significant differences were found in in‐hospital mortality (1% versus 2%), 30‐day major cardiac events (4% versus 4%), and mortality at 30 days (1% versus 2%) and 1 year (4% versus 4%).ConclusionsPatients with clinically defined SR have a favorable prognosis. Deferring immediate intervention seems to be safe in patients with clinical indices of spontaneous reperfusion.

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Section: Discussionmentioning

confidence: 81%

“…There are very few data regarding clinically defined SR in STE‐ACS patients 6, 7. While the most recent European and American practice guidelines8, 9 include patients with clinically defined SR within the context of non‐STE‐ACS, few specific recommendations are made for these patients.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred Angiography

Fefer

Beigel

Atar

et al. 2017

JAHA

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“…Also, stent implantation in culprit lesion on patent infarct related artery, may cause microembolisation by fragmentation of thrombi and may damage microvascular perfusion. Furthermore, reocclusion rate of the IRA in the patients with SCR was not observed at higher rates as it was feared (6,7,12,14).…”

Section: Discussionmentioning

confidence: 99%

“…In patients with STEMI undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery on initial angiography was associated with better angiographic results and improved prognosis compared with patients without spontaneous reflow (2)(3)(4)(5)(6)(7). Resolution of electrocardiographic ST-segment elevation after reperfusion therapy for acute myocardial infarction has been correlated with clinical outcomes and recovery of left ventricular function (8,9).…”

Section: Introductionmentioning

confidence: 99%

Amount of ST wave resolution in patients with and without spontaneous coronary reperfusion in the infarct -related artery after primary PCI: an observational study

Erden¹,

Erden²,

Türker³

et al. 2012

Anadolu Kardiyol Derg

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Primer PKG'den sonra enfarkt ilişkili arterde spontan reperfüzyon saptanan ve saptanmayan hastalarda ST segment rezolüsyon miktarı: Gözlemsel bir çalışma Original Investigation Özgün Araşt›rma ABSTRACTObjective: In patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery (IRA) on initial angiography was associated with better angiographic results and improved prognosis compared with patients without spontaneous reflow. The role of systematic emergency PCI in patients with spontaneous reperfusion during myocardial infarction is debated. We compared the amount of ST wave resolution (STR) in patients with and without spontaneous coronary reperfusion (SCR) in the infarct related artery. Methods: This study was designed as an observational cohort study. One hundred sixty-one consecutive patients (121 males, 40 females, with a mean age of 56±10 years) who had STEMI and treated with primary PCI without previous thrombolytic therapy were included in the study. All patients were treated with primary PCI within 12 hours from the onset of the symptoms and had stent implantation in the culprit lesion. ST wave resolution was measured as percent resolution of ST segment elevation from electrocardiogram (ECG), before and after PCI, classified as complete (>70%), partial (30% to 70%), or absent (<30%). SCR was defined as a TIMI grade III flow in the IRA on baseline coronary angiogram. The amount of ST wave resolution (STR) in patients with and without SCR in the IRA was compared. We used Chi-square test, Student's t-test and the Mann-Whitney U test for statistical analysis. Results: At the baseline coronary angiography 40 (25%) patients had SCR and 121 patients (75%) had TIMI flow grade 0, 1 or 2 (non-SCR group). ST segment resolution amount was significantly higher in patients without SCR (53±17 versus 13±23 mm; p<0.001). In fact; in five patients whom had patent infarct related artery in initial angiography, ST segment elevation increased according to pre-PCI ECG. Conclusion: Mean ST wave resolution was lower in patients with spontaneous coronary reperfusion who were treated with primary PCI compared to their counterparts who did not have spontaneous coronary reperfusion on initial coronary angiography. Yöntemler: Bu çalışma gözlemsel kohort çalışması olarak dizayn edildi. Çalışmaya ST elevasyonlu MI geçirmiş ve trombolitik tedavi uygulanmayıp primer PCI yapılan ortalama yaşı 56±10 yıl olan 161 hasta dahil edildi. Tüm hastalar semptom başlangıcından 12 saat içinde primer PKG'e alındı ve sorumlu lezyona stent implantasyonu yapıldı. ST rezolüsyonu, PKG öncesi ve sonrası elektrokardiyogramlarda (EKG) ST segment elevasyonunun yüzdesel gerilemesi olarak hesaplandı. >%70 tam rezolüsyon, %30 -%70 arası parsiyel rezolüsyon olarak adlandırıldı. <%30 rezolüs-yon olarak kabul edilmedi. Spontan koroner reperfüzyon, yapılan ilk anjiyoda enfarkt ilişkili arterde TIMI-III akım saptanması olarak kabul edildi.

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“…Спонтанная реперфу-зия (CР) -хорошо известная ситуация при ИМ с подъемом сегмента ST, но данные о её частоте широ-ко различаются (от 4% до 57%) [15][16][17]. При иссле-довании 710 больных ИМ с подъемом сегмента ST, «под-ходящих» для реперфузионной терапии [15], СР (опре-делявшаяся как уменьшение суммарной элевации сег-мента ST на 70% и более при сравнении с первона-чальной электрокардиограммой и уменьшение боли на 70%) наблюдалась у 155 больных (22%). Исходы у больных со СР были лучше, чем у больных без СР.…”

Section: причины отсутствия реперфузионной терапииunclassified

Therapy for St-Segment Elevation Myocardial Infarction Patients Who Present Late or Are Ineligible for Reperfusion

Cohen¹,

Boiangiu²,

Abidi³

et al. 2010

Racionalʹnaâ farmakoterapiâ v kardiologii

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Несмотря на широкую доступность фармакологических и механических методов реперфузии, в значительной части случаев инфаркта миокарда (ИМ) с подъемом сег-мента ST все еще не назначают реперфузионной терапии, а некоторых больных расценивают как «не подходящих для реперфузии». Только малая часть таких ситуа-ций связана со спонтанной реперфузией или наличием противопоказаний к применению фибринолитиков или механической реперфузии. В последних публикациях активно обсуждается граница между «своевременным» и «поздним» обращением за медицинской помощью, целесообразность чрескожного вмешательства у боль-ных, которые поздно обратились за медицинской помощью, а также влияние пола и возраста на возможность и/или выбор реперфузионной терапии. В настоящее время при надлежащем практическом применении научных доказательств и клинических рекомендаций реперфузионную терапию должны получать боль-шинство нуждающихся в ней больных ИМ с подъемом сегмента ST. Фармакологическая нетромболитическая терапия таких больных четко определена в современных рекомендациях. Имеющиеся данные свидетельствуют о том, что у больных, не получающих реперфузионного вмешательства, антикоагулянтная терапия низкомоле-кулярным гепарином обеспечивает четкое уменьшение летальности. В сравнении с обычным лечением (введение нефракционированного гепарина или плацебо) фон-дапаринукс существенно снижает частоту летальных исходов и повторных ИМ без увеличения частоты серьезных кровотечений или инсультов. При лечении поздно обратившихся больных ИМ с подъемом сегмента ST (позднее первых 12 ч после появления симптомов) клиническая оценка и стратификация риска представляются наиболее важными элементами, помогающими выбору терапевтического вмешательства. Ключевые слова: ишемическая болезнь сердца, антитромботическая терапия, инфаркт миокарда с подъемом сегмента ST. Целью своевременной и полной реперфузии коро-нарных артерий с использованием фибринолиза или первичного чрескожного вмешательства на коронарных артериях (ЧКВ) при ИМ с подъемом сегмента ST является уменьшение размеров инфаркта и снижение частоты не-благоприятных исходов и смерти. Современные реко-мендации поддерживают тактику проведения репер-фузионной терапии у всех больных ИМ с подъемом сег-мента ST, которые обратились за медицинской помо-щью не позднее 12 ч после появления симптомов [3][4][5], а недавний анализ данных регистра GRACE (Global Registry of Acute Coronary Events) указывает на пред-почтительное применение первичного ЧКВ [6]. Одна-ко значительной доле таких больных не назначается ре-перфузионная терапия, а некоторые из них считаются «не подходящими» для реперфузионной терапии. В об-зоре рассмотрены проблема «ИМ без реперфузионной терапии» и её причины, проанализированы анти-тромботическая и неантитромботическая терапия (уменьшающая работу сердца и др.) больных, которым не проводилась реперфузионная терапия. ИМ с подъемом сегмента ST без реперфузионной терапии Масштаб проблемыПо данным Германского регистра MITRA (Maximal In-

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Relation of Clinically Defined Spontaneous Reperfusion to Outcome in ST-Elevation Myocardial Infarction

Cited by 34 publications

References 10 publications

Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred Angiography

Outcomes of Patients Presenting With Clinical Indices of Spontaneous Reperfusion in ST‐Elevation Acute Coronary Syndrome Undergoing Deferred Angiography

Amount of ST wave resolution in patients with and without spontaneous coronary reperfusion in the infarct -related artery after primary PCI: an observational study

Therapy for St-Segment Elevation Myocardial Infarction Patients Who Present Late or Are Ineligible for Reperfusion

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