Transradial artery approach in STEMI patients reperfused early and late by either primary PCI or pharmaco-invasive approach

Sultan, El-Zahraa M.; Rabea, Hoda; abdelmeguid, Khaled R.; Mahmoud, Hesham B.

doi:10.1016/j.ehj.2017.04.001

Cited by 3 publications

(3 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It seems that no extra risk of complications is expected when using SK in early PI approach if late PPCI is the other option especially when combining it with radial technique. 19 Patients who reperfused early (≤3 hrs) or late (>3 hrs) by streptokinase in PI approach had encouraging results regarding LVEF, myocardium wall motion and preservation, and TIMI flow. Less use of suction device and IV GPI inhibitors administration were observed without increasing the complications risk.…”

Section: Discussionmentioning

confidence: 93%

See 1 more Smart Citation

Safety and Efficacy of Pharmaco-invasive Approach Using Streptokinase Compared With Primary Percutaneous Coronary Angiography

Sultan

Elberry

Rabea

et al. 2020

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

Self Cite

View full text Add to dashboard Cite

Background: Fibrin-specific fibrinolytics are preferred when they used in STEMI patients (pharmaco-invasive approach). However, streptokinase is still the most common used thrombolytic agent in Egypt because of its cheaper cost. Methods: 266 STEMI patients were randomly assigned to undergo PPCI or pharmacoinvasive (using streptokinase). Primary end point (death, shock, congestive heart failure, or reinfarction up to 30 d) and secondary end point (ischemic stroke, intracranial hemorrhage, or nonintracranial bleeding) were followed for 30 days after reperfusion. In pharmaco-invasive arm, urgent coronary angiography was performed in case of failed reperfusion. Based on the reperfusion time from symptoms onset, patients in both arms were divided into; early (≤3 hrs) and late reperfusion (>3 hrs). Results: No statistical significant difference regarding left ventricular ejection fraction, end diastolic and end systolic diameter in both arms. Early PPCI (≤3 hrs) had highest ejection fraction values (56.9 ± 7.5). Myocardial wall preservation was best achieved in early pharmaco-invasive (≤3 hrs). There was no statistical significant difference in TIMI flow results between all subgroups (early and late of both arms) (P = 0.750). Suction devices and IV Eptifibatide were less frequently used in the pharmaco-invasive comparing to PPCI arm; (P = 0.000 and P = 0.006) subsequently. No statistical significant difference regarding complication incidence in both arms (P = 0.518). Radial access was more commonly used in the pharmaco-invasive arm (P = 0.015). Conclusion:Utilizing streptokinase in early re-perfused patients by PI approach (≤3 hrs) seems safe and efficient when PPCI delay (>120 min from symptom onset) is the other option.

show abstract

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Pharmaco-invasive Approach Using Streptokinase Compared With Primary Percutaneous Coronary Angiography

Sultan

Elberry

Rabea

et al. 2020

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…11 The effectiveness of the pharmacoinvasive strategy does not depend on initial troponin levels, 12 and the radial access was considered safe and effective in the pharmacoinvasive strategy. 13 The EARLY-MYO Study demonstrated that in patients with STEMI presenting less than 6 h after symptom onset and expected delay to PCI, the pharmacoinvasive strategy with half-dose of alteplase was not inferior to PCI in complete epicardial and myocardial reperfusion evaluated defined as thrombolysis in myocardial infarction (TIMI) grade 3, TIMI perfusion grade 3 and resolution of the ST segment ≥70% in 60 minutes. 14 In patients who admitted within 6 hours of STEMI and underwent PCI, intracoronary administration of low doses of alteplase had no effect on the degree of microvascular obstruction or on clinical outcomes.…”

Section: Pharmacoinvasive Therapymentioning

confidence: 99%

Reperfusion Strategies in Acute Myocardial Infarction: State of the Art

Rangel¹

2021

International Journal of Cardiovascular Sciences

View full text Add to dashboard Cite

ST elevation myocardial infarction (STEMI) is a highly prevalent condition worldwide. Reperfusion therapy is strongly associated with the prognosis of STEMI and must be performed with a high standard of quality and without delay. A systematic review of different reperfusion strategies for STEMI was conducted, including randomized controlled trials that included major cardiovascular events (MACE), and systematic reviews in the last 5 years through the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology. The research was done in the PubMed and Cochrane Central Register of Controlled Trials databases, in addition to a few manual searches. After the exclusion criteria were applied, 90 articles were selected for this review. Despite the reestablishment of IRA patency in PCI for STEMI, microvascular lesions occur in a significant proportion of these patients, which can compromise ventricular function and clinical course. Several therapeutic strategies -intracoronary administration of nicorandil, nitrates, melatonin, antioxidant drugs (quercetin, glutathione), antiinflammatory substances (tocilizumab [an inhibitor of interleukin 6], inclacumab, P-selectin inhibitor), immunosuppressants (cyclosporine), erythropoietin and ischemic pre-and post-conditioning and stem cell therapy -have been tested to reduce reperfusion injury, ventricular remodeling and serious cardiovascular events, with heterogeneous results: These therapies need confirmation in larger studies to be implemented in clinical practice PrevalenceThe worldwide prevalence of ischemic heart disease is approximately 111 million cases, with 7.3 million cases of fatal acute myocardial infarction (AMI) in 2015. The inadequate treatment of patients with AMI is associated with significant increases in morbidity and mortality. 1 ObjectivesThe objective of this systematic review is to evaluate the evidence of different reperfusion therapies in STsegment elevation AMI (STEMI), selecting mainly randomized controlled trials and systematic reviews that address major cardiovascular clinical outcomes. MethodsThe review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We searched the PubMed database for the terms "acute myocardial infarction" and "reperfusion therapy", which yielded 9,885 results. After applying the following search filters -type of abstract: "text and full text"; type of article: "metaanalysis, review, systematic review and randomized clinical trial", and date of publication: "last 5 years", and language: "English" -127 articles were obtained. In addition, research was conducted at the Cochrane Central Register of Controlled Trials using the terms "acute myocardial infarction" and "reperfusion therapy", in English, between 2018 and 2020, which revealed 64 clinical trials, already excluding duplicates. Of the 191

show abstract

Post-streptokinase PCI in STEMI patients exceeding the 24-h guidelines

Sultan

Meguid

Mahmoud

2021

Beni-Suef Univ J Basic Appl Sci

View full text Add to dashboard Cite

Background Due to delay in obtaining approval from insurance institution, performing PCI after successful reperfusion using streptokinase was postponed for ˃24 h-1 week. The study was conducted to investigate safety and efficacy of such delay in comparison to the ideal guidelines of PCI (≤ 24 h) in 129 STEMI patients received streptokinase followed by PCI. Patients were divided into two groups: (group 1 = 57; early PCI ≤ 24 h.) and (group 2 = 72; late PCI > 24 h.). Results Primary end point was death, congestive heart failure and reinfarction up to 30 days. Secondary end point was TIMI flow < G3, ischemic stroke, intracranial hemorrhage and non-intracranial bleeding. No statistical significant difference was found between both groups regarding LVEF, dimensions and myocardium wall preservation and incidence of complications and TIMI flow. No primary endpoints were detected. Five patients had secondary endpoints in early PCI and four in the late PCI. Suction device and IV Eptifibatide were used more in early PCI (p = 0.003). Conclusions The study suggests that relatively late PCI (> 24 h–1wk) after successful reperfusion using streptokinase in STEMI patients seems to be safe and effective in 30-day follow-up, provided that patients received DAPT and were subjected to close observation. The results seem safely applicable when we are forced to this choice; however lack of more investigations to this hypothesis is considered a limitation.

show abstract

Transradial artery approach in STEMI patients reperfused early and late by either primary PCI or pharmaco-invasive approach

Cited by 3 publications

References 22 publications

Safety and Efficacy of Pharmaco-invasive Approach Using Streptokinase Compared With Primary Percutaneous Coronary Angiography

Safety and Efficacy of Pharmaco-invasive Approach Using Streptokinase Compared With Primary Percutaneous Coronary Angiography

Reperfusion Strategies in Acute Myocardial Infarction: State of the Art

Post-streptokinase PCI in STEMI patients exceeding the 24-h guidelines

Contact Info

Product

Resources

About