Share This Article:

Ultra Early Routine Post-Fibrinolysis Angioplasty Benefits More Patients with Acute ST-Elevation Myocardial Infarction

Abstract PP. 1-7
DOI: 10.4236/oalib.1101109    1,465 Downloads   1,730 Views   Citations

ABSTRACT

Objective: Evaluate whether early routine post-fibrinolysis angioplasty represents a reasonable reperfusion option for victims of ST-elevation myocardial infarction (STEMI), so that these patients could benefit more. Methods: A total of 936 STEMI patients were enrolled in this study to full Urokinase within 3 hours (h) followed by stenting within 3 - 12 h (Ultra early routine post-fibrinolysis angioplasty; 472 patients), or primary stenting within 12 h (primary angioplasty; 464 patints). The primary endpoints were the reperfusion time within 3 h and the incidence of no-reflow or slow-reflow. The secondary endpoints were the acute incidence of bleeding, the extent of myocardial damage, determined by the 6-month left ventricular function and the 3-year composite incidence of death, reinfarction, stroke, or revascularization. Results: Ultra early routine post-fibrinolysis angioplasty significantly increased the percentage of reperfusion treatment within 3 hours (P < 0.01). The primary angioplasty group resulted in higher frequency of no-reflow or slow-reflow (P < 0.01). Both groups were similar regarding major bleeding (P > 0.05). The 6-month left ventricular function of early routine post-fibrinolysis angioplasty group was better than primary angioplasty group. Both groups were similar regarding reinfarction, stroke or revascularization (P > 0.05), but the incidence of 3-year cumulative death is higher in the primary angioplasty group (P < 0.01). Conclusion: Ultra early routine post-fibrinolysis angioplasty can significantly improve effective time window within effective reperfusion treatment percentage, results in better myocardial perfusion, lower no-reflow and preserving left ventricular function and the prognosis of patients with STEMI than primary angioplasty.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

He, X. , Wan, X. , Luo, M. , Wang, H. , Zhong, Q. , Peng, W. and Xue, J. (2014) Ultra Early Routine Post-Fibrinolysis Angioplasty Benefits More Patients with Acute ST-Elevation Myocardial Infarction. Open Access Library Journal, 1, 1-7. doi: 10.4236/oalib.1101109.

References

[1] Van de Werf, F., Bax, J., Betriu, A., et al. (2008) Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation. European Heart Journal, 29, 2909-2945.
http://dx.doi.org/10.1093/eurheartj/ehn416
[2] Institute of Medicine (2011) Finding What Works in Health Care: Standards for Systematic Reviews. The National Academies Press, Washington DC.
[3] Silber, S., Albertsson, P., Aviles, F.F., et al. (2005) Guidelines for Percutaneous Coronary Interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. European Heart Journal, 26, 804-847.
http://dx.doi.org/10.1093/eurheartj/ehi138
[4] Cantor, W.J., Burnstein, J., Choi, R., et al. (2006) Transfer for Urgent Percutaneous Coronary Intervention Early after Thrombolysis for ST-Elevation Myocardial Infarction: The TRANSFER-AMI Pilot Feasibility Study. Canadian Journal of Cardiology, 22, 1121-1126.
http://dx.doi.org/10.1016/S0828-282X(06)70948-5
[5] Eagle, K.A., Nallamothu, B.K., Mehta, R.H., et al. (2008) Trends in Acute Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction from 1999 to 2006: We Are Getting Better but We Have Got a Long Way to Go. European Heart Journal, 29, 609-617.
http://dx.doi.org/10.1093/eurheartj/ehn069
[6] Assessment of the Safety and Efficacy of a New Treatment Strategry with Percutaneous Coronary Intervention (ASSENT-4 PCI) Investigators (2006) Primary versus Tenecteplase-Facilitated Percutaneous Coronary Intervention in Patients with ST Segment Elevation Acute Myocardial Infarction (ASSENT-4 PCI): Randomised Trial. Lancet, 367, 569-578.
http://dx.doi.org/10.1016/S0140-6736(06)68147-6
[7] Levine, G.N., Bates, E.R., Blankenship, J.C., et al. (2011) 2011ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Journal of the American College of Cardiology, 58, e44-e122.
http://dx.doi.org/10.1016/j.jacc.2011.08.007
[8] Rittersma, S.Z.H., Vander Wal, A.C., Koch, K.T., Piek, J.J., et al. (2005) Plaque Instability Frequently Occurs Days or Weeks before Occlusive Coronary Thrombosis—A Pathological Thrombectomy Study in Primary Percutaneous Coronary Intervention. Circulation, 111, 1160-1165.
http://dx.doi.org/10.1161/01.CIR.0000157141.00778.AC
[9] Pinto, D.S., Kirtane, A.J., Nallamothu, B.K., et al. (2006) Hospital Delays in Reperfusion for ST-Elevation Myocardial Infarction: Implications When Selecting a Reperfusion Strategy. Circulation, 114, 2019-2025.
http://dx.doi.org/10.1161/CIRCULATIONAHA.106.638353
[10] Di Mario, C., Dudek, D., Piscione, F., et al., CARESS-in-AMI (Combined Abciximab RE-Teplase Stent Study in Acute Myocardial Infarction) Investigators (2008) Immediate Angioplasty versus Standard Therapy with Rescue Angioplasty after Thrombolysis in the Combined Abciximab Reteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI): An Open, Prospective, Randomised, Multicentre Trial. Lancet, 371, 559-568.
http://dx.doi.org/10.1016/S0140-6736(08)60268-8
[11] Zijlstra, F., Patel, A., Jones, M., et al. (2002) Clinical Characteristics and Outcome of Patients with Early (<2 h), Intermediate (2 - 4 h) and Late (>4 h) Presentation Treated by Primary Coronary Angioplasty or Thrombolytic Therapy for Acute Myocardial Infarction. European Heart Journal, 23, 550-557.
http://dx.doi.org/10.1053/euhj.2001.2901
[12] Antoniucci, D., Valenti, R., Migliorini, A., et al. (2002) Relation of Time to Treatment and Mortality in Patients with Acute Myocardial Infarction Undergoing Primary Coronary Angioplasty. American Journal of Cardiology, 89, 1248-1252.
http://dx.doi.org/10.1016/S0002-9149(02)02320-2
[13] Gershlick, A.H., Stephens-Lloyd, A., Hughes, S., et al., REACT Trial Investigators (2005) Rescue Angioplasty after Failed Thrombolytic Therapy for Acute Myocardial Infarction. New England Journal of Medicine, 353, 2758-2768.
http://dx.doi.org/10.1056/NEJMoa050849
[14] Dudek, D., Dziewierz, A., Rakowski, T., et al. (2006) Angiographic and Clinical Outcome after Percutaneous Coronary Interventions Following Combined Fibrinolytic Therapy in Acute Myocardial Infarction. Kardiologia Polska, 64, 239-247.
[15] Dudek, D., Mielecki, W., Zalewski, J., et al. (2006) Influence of Immediate or Delayed Angioplasty after Successful Thrombolysis on Left Ventricle Remodeling in Cardiac Magnetic Resonance. American Journal of Cardiology, 8, 138.
http://dx.doi.org/10.1002/clc.20818
[16] He, X.-Z., Zhou, S.-H., Wan, X.-H., et al. (2011) The Effect of Early and Intensive Statin Therapy on Ventricular Premature Beat or Nonsustained Ventricular Tachycardia in Patients with Acute Coronary Syndrome. Clinical Cardiology, 34, 59-63.

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.