Relationship Between the Generation and the Facilitated Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction-Analysis Based on the Fibrinolysis and Subsequent Transluminal Trial-

Abstract

ne of the most important factors influencing the success of treatment of acute myocardial infarction (AMI) is the speed with which revascularization of the involved coronary arteries can be accomplished. According to the guidelines issued by the American Heart Association (AHA) and American College of Cardiology (ACC), patients under 75 years of age with myocardial infarction should be administered thrombolytic therapy within 30 min of "Door-to-Needle" time, or by percutaneous coronary intervention (PCI) within 90±30 min of "Door-toBalloon" time. [1][2][3][4] Since a report of favorable outcomes in the PACT trial, 5 facilitated PCI, in which PCI is conducted after anticipatory administration of thrombolytic therapy, has been drawing attention. 6-8 Facilitated PCI is considered to be a promising treatment strategy, based on the following consideration; the overall therapeutic outcome of AMI may be improved even at institutions where PCI cannot be Circulation Journal Vol.68, December 2004 performed, since a therapeutic outcome equivalent to or superior to that obtained by primary PCI may be achieved by anticipatory administration of a thrombolytic agent, followed by PCI at a suitable institution after the transfer of the patient. Group involved in the present study has devised a treatment strategy consisting of FAST therapy for patients in whom a diagnosis of AMI can be made immediately after arrival at the hospital. In the FAST therapy, intravenous administration of a mutant tissue-type plasminogen activator (t-PA), which can be administered rapidly as a bolus injection, is followed by coronary angiography, and then, PCI is conducted in patients in whom TIMI-3 has not been achieved as evaluated by the coronary angiography (CAG). The present study group has reported a favorable therapeutic outcome of this trial. FAST therapy, including FAST-1, 9 and FAST-2, 10 in which t-PA or mutant t-PA is used, reduced the incidence of myocardial damage with the risk of complications. In the FAST-3 trial, in which the relationship between the "Door-to-TIMI-3" time and the extent of myocardial salvage was also assessed, 11 the "Door-to-TIMI-3" time was confirmed to have considerable influence on the extent of the infarction, and based on the results of the trial, a "Door-to-TIMI-3" time of 55 min was recommended. Taking into consideration the present situation in Japan, in which the age of the population is steadily increasing, we investigated the limitations of the FAST-3 therapy imposed by age, the safety of the treatment protocol in various age groups, and the indications for the FAST-3 protocol. Background The purpose of the present study was to evaluate the efficacy and safety of facilitated percutaneous coronary intervention (PCI) in comparing young and elderly patients with acute myocardial infarction. Methods and ResultsThe present study enrolled 168 initial myocardial infarction patients within 12 h of the symptom onset between 40 and 80 years of age who were indicated on the fibrinolysis and subsequent transluminal ...

Medium-Term Prognosis of Young Japanese Adults Having Acute Myocardial Infarction

“…13 Regarding facilitated PCI, a recent report has indicated that efficacy and safety do not differ between young and elderly patients with AMI. 26 As to the long-term outcome of PCI, previous studies have indicated that young patients with angina have a high need for repeat revascularization and many of them suffer another AMI in the follow-up period, 27 and that young patients with AMI have a low restenosis rate. 28 The present results suggests that the medium-term efficacy of primary PCI for young AMI patients is comparable to that in non-young AMI patients in Japan.…”

Acute Myocardial Infarction in Young Japanese Adults Clinical Manifestations and In-Hospital Outcome

“…Regarding facilitated PCI, a recent report has demonstrated that the efficacy and safety of PCI do not differ between young and elderly patients with AMI. 21 Previous studies concerning young patients with stable angina, unstable angina and AMI showed that the balloon angioplasty in younger populations has a high immediate success rate with relatively few complications. 22,23 In contrast, as to long-term outcome of PCI, young patients with angina have a high need for repeat revascularization and many of them suffer an AMI in follow-up period, 22 while young patients with AMI have a low re-stenosis rate.…”

Impact of Doctor Car with Mobile Cloud ECG in Reducing Door-to- Balloon Time of Japanese ST-Elevation Myocardial Infarction Patients

“…15) Shortening the door-to-balloon time as much as possible is very important for achieving a better prognosis in STEMI patients. [16][17][18][19][20] Guidelines recommend that STEMI patients should receive primary percutaneous coronary intervention (PCI) within 90 minutes. 21,22) As we have reported previously, 15,23) our Doctor Car is equipped with a mobile cloud electrocardiography system.…”