Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA-1): a randomised controlled trial

Very Early versus Early Invasive Strategy after Successful Thrombolysis in Patients with ST Segment Elevation Myocardial Infarction

“…The mean and standard deviation of the time from symptom onset to presentation is considered to be comparable to other studies in which this time duration varied from at least 20 min in the WEST study and up to 12 h in the TRANSFER-AMI, [5] CARESS-AMI, [6] GRACIA-I, [18] and SIAM III [19] studies. Both groups achieved adequate results regarding the TIMI flow and MBG with no timing superiority in the first 24 hours.…”

“…For example; Cantor WJ et al, in the TRANSFER AMI defined early PCI as immediate transfer of the patients post thrombolysis and to intervene in a period less than 6 hours, [5] while Di Mario C et al [6], in the CARESS-IN AMI trial defined early PCI as performance of intervention within 3.5 hours from hospital admission [6]. The definition of early PCI group in the GRACIA-1 trial was extended up to 24 hours from thrombolysis [18].…”

“…The trials that addressed the timing issue post thromblysis (The WEST, [20] NORDISTEMI, [7] TRANSFER AMI, [5] CAPITAL AMI, [21] CARESS-IN-AMI [6] and GRACIA1 [18]) showed significant difference between comparable groups regarding the composite end point of death/reinfarction/ recurrent ischemia favoring routine early PCI group over ischemia driven delayed PCI. The advantage of routine early angioplasty over the delayed ischemia driven PCI group was shown despite the variation of time from lytic therapy to PCI which varied from 3 hours in most of these studies to 13 hours in the GRACIA 1 trial [18]. That is why when comparing the results of these studies to our work it should be put into consideration that the two groups in our study were within the optimum window of intervention post thrombolysis and this may be the explanation why there was no significant difference between the two groups regarding the composite end point.…”

Das initiale Management des akuten Koronarsyndroms

“…Diese Strategie schließt die frühe Verlegung zur Angiographie und, wenn nö-tig, PCI nach Fibrinolyse ein. Daten aus 7 RCTs mit 2355 Patienten [138,146,[154][155][156][157][158] ergaben Vorteile bezüglich weniger Reinfarkte bei früher regelhafter Verlegung zur Angiographie nach 3−6 h (bis zu 24 h) in den ersten 24 h nach Fibrinolyse im Vergleich zur reinen Verlegung auf die Rescue-PCI nach Fibrinolyse im Krankenhaus (OR 0,57; 95 %-CI 0,38-0,85). Es ergaben sich keine Vorteile bezüglich der kurzzeitigen und Einjahressterblichkeit bzw.…”

Intervenção coronária percutânea eletiva após fibrinólise: dados do REMAT (registro Madre Teresa)

“…Quanto à análise dos desfechos maiores, a exemplo de publicações nacionais [9][10][11] , nota-se elevado ín-dice de sucesso do procedimento (com porcentual próximo a 90%) e baixo porcentual de eventos adversos, fato atribuído à maior experiência acumulada dos cardiologistas invasivos do Serviço de Hemodinâmica, visto que curva de aprendizado e volume de procedimentos influenciam decisivamente os resultados da ICP, como divulgado por relevante registro americano. 12 Em especial, salienta-se baixa taxa de mortalidade (3,3%), comparável à encontrada em ensaios internacionais, como a metanálise publicada por Collet et al 13 (3,8%), ressalvando-se que nos ensaios internacionais os fibrinolíticos mais utilizados foram alteplase ou reteplase e o tempo médio de realização da ICP foi extremamente precoce.…”