101
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O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2012; 127:e362-425. [PMID: 23247304 DOI: 10.1161/cir.0b013e3182742cf6] [Citation(s) in RCA: 1071] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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102
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O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2012; 127:529-55. [PMID: 23247304 DOI: 10.1161/cir.0b013e3182742c84] [Citation(s) in RCA: 1834] [Impact Index Per Article: 152.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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103
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O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2012; 61:e78-e140. [PMID: 23256914 DOI: 10.1016/j.jacc.2012.11.019] [Citation(s) in RCA: 2191] [Impact Index Per Article: 182.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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104
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Godiwala T, Srivastava M, Gupta A. Reperfusion strategies and systems of care in ST-elevation myocardial infarction. Cardiol Clin 2012; 30:629-37. [PMID: 23102037 DOI: 10.1016/j.ccl.2012.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Approximately 330,000 ST-elevation myocardial infarctions (STEMI) occur yearly in the United States. Emergent reperfusion is the cornerstone of STEMI therapy and the key to restoration of coronary blood flow in an infarct-related vessel. Reperfusion methods include thrombolysis, primary percutaneous coronary intervention, or both methods combined. Selection of the appropriate reperfusion strategy is essential, along with having an efficient system of care capable of delivering these therapies. Timely reperfusion is highly dependent on a well-structured care system designed to meet the needs of each individual community. This article reviews the data behind different reperfusion strategies and introduces successful systems-of-care models.
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Affiliation(s)
- Tapan Godiwala
- Department of Cardiology, University of Maryland, 110 South Paca Street, 7th Floor, Baltimore, MD 21201, USA
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105
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Dharma S, Juzar DA, Firdaus I, Soerianata S, Wardeh AJ, Jukema JW. Acute myocardial infarction system of care in the third world. Neth Heart J 2012; 20:254-9. [PMID: 22328356 DOI: 10.1007/s12471-012-0259-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND We studied the characteristics of ST-elevation myocardial infarction (STEMI) patients from a local acute coronary syndrome (ACS) registry in order to find and build an appropriate acute myocardial infarction (AMI) system of care in Jakarta, Indonesia. METHODS Data were collected from the Jakarta Acute Coronary Syndrome (JAC) registry 2008-2009, which contained 2103 ACS patients, including 654 acute STEMI patients admitted to the National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. RESULTS The proportion of patients who did not receive reperfusion therapy was 59% in all STEMI patients and the majority of them (52%) came from inter-hospital referral. The time from onset of infarction to hospital admission was more than 12 h in almost 80% cases and 60% had an anterior wall MI. In-hospital mortality was significantly higher in patients who did not receive reperfusion therapy compared with patients receiving acute reperfusion therapy, either with primary percutaneous coronary intervention (PPCI) or fibrinolytic therapy (13.3% vs 5.3% vs 6.2%, p < 0.001). CONCLUSION The Jakarta Cardiovascular Care Unit Network System was built to improve the care of AMI in Jakarta. This network will harmonise the activities of all hospitals in Jakarta and will provide the best cardiovascular services to the community by giving two reperfusion therapy options (PPCI or pharmaco-invasive strategy) depending on the time needed for the patient to reach the cath-lab.
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Affiliation(s)
- S Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jl S Parman Kav 87, Slipi, Jakarta Barat, 11420, Jakarta, Indonesia,
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106
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Gill J, Amin A, Parekh N, Nanjundappa A, Dieter RS. Lessons Learned from STEMI Clinical Trials. Interv Cardiol Clin 2012; 1:401-407. [PMID: 28581958 DOI: 10.1016/j.iccl.2012.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Coronary artery disease is the leading cause of the death in the United States. From 2009 to 2010, however, the rate of heart disease causing death decreased by 2.5% in part due to evolving techniques used to treat and prevent heart disease. Management of acute ST-segment elevation myocardial infarction (STEMI) has evolved accordingly and the studies investigating treatment strategies that have led to an evidence-based approach are reviewed in this article.
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Affiliation(s)
- Jasrai Gill
- Department of Medicine, Loyola University Medical Center, 2160 Maywood, IL 60153, USA
| | - Anish Amin
- Department of Medicine, Loyola University Medical Center, 2160 Maywood, IL 60153, USA
| | - Niraj Parekh
- Department of Medicine, Loyola University Medical Center, 2160 Maywood, IL 60153, USA
| | - Aravinda Nanjundappa
- West Virginia University, 3100 McCorkle Avenue Southwest, Charleston, WV 25304, USA.
| | - Robert S Dieter
- Department of Interventional Cardiology, Loyola University Medical Center, 2160 Maywood, IL 60153, USA; Cardiovascular Collaborative Hines, VA Hospital, Illinois, USA
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107
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Abstract
The goal of treatment of patients with ST-segment elevation myocardial infarction (STEMI) is timely restoration of myocardial blood flow. Primary percutaneous coronary intervention (PCI) remains the treatment of choice for STEMI patients, as shown in multiple clinical trials. However, because of logistic constraints, timely primary PCI may not be possible for many STEMI patients, most of whom are treated with fibrinolysis. Debate continues as to whether, and when, patients treated with fibrinolysis should undergo subsequent PCI. Current data support the strategy of early routine PCI after fibrinolysis rather than the conservative standard-care approach or rescue PCI for failed lysis.
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Affiliation(s)
- Balaji Pakshirajan
- Department of Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A Dr. JJ Nagar, Mogappair, Chennai 600037, India
| | - Vijayakumar Subban
- Department of Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A Dr. JJ Nagar, Mogappair, Chennai 600037, India
| | - Ajit S Mullasari
- Department of Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A Dr. JJ Nagar, Mogappair, Chennai 600037, India.
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108
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Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van 't Hof A, Widimsky P, Zahger D. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33:2569-619. [PMID: 22922416 DOI: 10.1093/eurheartj/ehs215] [Citation(s) in RCA: 3661] [Impact Index Per Article: 305.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
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- AP-HP, Hôpital Bichat / Univ Paris Diderot, Sorbonne Paris-Cité / INSERM U-698, Paris, France.
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Hong MK. Recent Advances in the Treatment of ST-Segment Elevation Myocardial Infarction. SCIENTIFICA 2012; 2012:683683. [PMID: 24278728 PMCID: PMC3820598 DOI: 10.6064/2012/683683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 09/12/2012] [Indexed: 06/02/2023]
Abstract
ST-segment elevation myocardial infarction (STEMI) represents the most urgent condition for patients with coronary artery disease. Prompt diagnosis and therapy, mainly with primary angioplasty using stents, are important in improving not only acute survival but also long-term prognosis. Recent advances in angioplasty devices, including manual aspiration catheters and drug-eluting stents, and pharmacologic therapy, such as potent antiplatelet and anticoagulant agents, have significantly enhanced the acute outcome for these patients. Continuing efforts to educate the public and to decrease the door-to-balloon time are essential to further improve the outcome for these high-risk patients. Future research to normalize the left ventricular function by autologous stem cell therapy may also contribute to the quality of life and longevity of the patients surviving STEMI.
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Affiliation(s)
- Mun K. Hong
- Cardiac Catheterization Laboratory and Interventional Cardiology, St. Luke's-Roosevelt Hospital Center, 1111 Amsterdam Avenue, New York, NY 10025, USA
- Columbia University College of Physicians and Surgeons, 630 W. 168th St., New York, NY 10032, USA
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Savonitto S, Cavallini C, Petronio AS, Murena E, Antonicelli R, Sacco A, Steffenino G, Bonechi F, Mossuti E, Manari A, Tolaro S, Toso A, Daniotti A, Piscione F, Morici N, Cesana BM, Jori MC, De Servi S. Early Aggressive Versus Initially Conservative Treatment in Elderly Patients With Non–ST-Segment Elevation Acute Coronary Syndrome. JACC Cardiovasc Interv 2012; 5:906-16. [DOI: 10.1016/j.jcin.2012.06.008] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 05/29/2012] [Accepted: 06/07/2012] [Indexed: 01/12/2023]
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111
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Abstract
Disruption of intracoronary plaque with thrombus formation provides the pathophysiologic foundation for acute coronary syndromes, which comprise ST-segment myocardial infarction, non-ST-segment myocardial infarction, and unstable angina. Management differs depending on whether ST-segment elevation is present, but the general principles of timely restoration of coronary blood flow and initiation of secondary prevention strategies are applicable to all patients. The purpose of this review is to discuss first the epidemiology, pathophysiology, and diagnosis of acute myocardial infarction. Risk stratification and therapy for patients with ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndromes are then reviewed along with diagnosis and management of the complications of myocardial infarction.
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112
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Sobhy M, Sadaka M, Okasha N, Farag ES, Saleh A, Ismail H, El Seteiha M, Ragy H, Hameed MA, Mehanna R. Stent for Life Initiative placed at the forefront in Egypt 2011. EUROINTERVENTION 2012; 8 Suppl P:P108-15. [PMID: 22917780 DOI: 10.4244/eijv8spa19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Mohamed Sobhy
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
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113
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2012; 79:453-95. [PMID: 22328235 DOI: 10.1002/ccd.23438] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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114
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Dauerman HL, Sobel BE. Toward a comprehensive approach to pharmacoinvasive therapy for patients with ST segment elevation acute myocardial infarction. J Thromb Thrombolysis 2012; 34:180-6. [DOI: 10.1007/s11239-012-0722-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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115
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Shugman IM, Hsieh V, Cheng S, Parikh D, Tobing D, Wouters N, van der Vijver R, Lo Q, Rajaratnam R, Hopkins AP, Lo S, Leung D, Juergens CP, French JK. Safety and efficacy of rescue angioplasty for ST-elevation myocardial infarction with high utilization rates of glycoprotein IIb/IIIa inhibitors. Am Heart J 2012; 163:649-56.e1. [PMID: 22520531 DOI: 10.1016/j.ahj.2012.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 01/10/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Fibrinolytic therapies remain widely used for ST-elevation myocardial infarction, and for "failed reperfusion," rescue percutaneous coronary intervention (PCI) is guideline recommended to improve outcomes. However, these recommendations are based on data from an earlier era of pharmacotherapy and procedural techniques. METHODS AND RESULTS To determine factors affecting prognosis after rescue PCI, we studied 241 consecutive patients (median age 55 years, interquartile range [IQR] 48-65) undergoing procedures between 2001 and 2009 (53% anterior ST-elevation myocardial infarction and 78% transferred). The median treatment-related times were 1.2 hours (IQR 0.8-2.2) from symptom onset to door, 2 hours (IQR 1.3-3.2) from symptom onset to fibrinolysis (93% tenecteplase), and 3.9 hours (IQR 3.1-5.2) from fibrinolysis to balloon. Procedural characteristics were stent deployment in 95% (11.6% drug eluting) and 78% glycoprotein IIb/IIIa inhibitor use, and Thrombolysis In Myocardial Infarction (TIMI) 3 flow rates pre-PCI and post-PCI were 41% and 91%, respectively (P < .001). At 30 days, TIMI major bleeding occurred in 16 (6.6%) patients, and 23 (9.5%) patients received transfusions; nonfatal stroke occurred in 4 (1.7%) patients (2 hemorrhagic). Predictors of TIMI major bleeding were female gender (odds ratio 3.194, 95% CI 1.063-9.597; P = .039) and pre-PCI shock (odds ratio 3.619, 95% CI,1.073-12.207; P = .038). Mortality at 30 days was 6.2%, and 3.2% in patients without pre-PCI shock. One-year mortality was 8.2% (5.3% in patients without pre-PCI cardiogenic shock), 5.2% had reinfarction, and the target vessel revascularization rate was 6.4% (2.6% in arteries ≥ 3.5 mm in diameter). Pre-PCI shock, female gender, and post-PCI TIMI flow grades ≤ 2 were significant predictors of 1-year mortality on multivariable regression modeling, but TIMI major bleeding was not. CONCLUSIONS Rescue PCI with contemporary treatments can achieve mortality rates similar to rates for contemporary primary PCI in patients without pre-PCI shock. Whether rates of bleeding can be reduced by different pharmacotherapies and interventional techniques needs clarification in future studies.
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Affiliation(s)
- Ibrahim M Shugman
- Department of Cardiology, Liverpool Hospital, South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
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116
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117
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Timing of events in STEMI patients treated with immediate PCI or standard medical therapy: Implications on optimisation of timing of treatment from the CARESS-in-AMI trial. Int J Cardiol 2012; 154:275-81. [DOI: 10.1016/j.ijcard.2010.09.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 09/16/2010] [Indexed: 11/22/2022]
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118
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary. J Am Coll Cardiol 2011. [DOI: 10.1016/j.jacc.2011.08.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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119
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120
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2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58:e44-122. [PMID: 22070834 DOI: 10.1016/j.jacc.2011.08.007] [Citation(s) in RCA: 1724] [Impact Index Per Article: 132.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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121
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:2574-609. [PMID: 22064598 DOI: 10.1161/cir.0b013e31823a5596] [Citation(s) in RCA: 387] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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122
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574-651. [PMID: 22064601 DOI: 10.1161/cir.0b013e31823ba622] [Citation(s) in RCA: 902] [Impact Index Per Article: 69.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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123
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Catheter Cardiovasc Interv 2011; 82:E266-355. [DOI: 10.1002/ccd.23390] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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124
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Cuisset T, Pankert M, Quilici J. Synergy between pharmacological and mechanical reperfusion in ST-segment elevation myocardial infarction patients: 2011 update. J Cardiovasc Med (Hagerstown) 2011; 12:860-7. [PMID: 22045096 DOI: 10.2459/jcm.0b013e32834da519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Thomas Cuisset
- Département de Cardiologie, CHU Timone, Marseille, France.
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125
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Fitchett DH, Theroux P, Brophy JM, Cantor WJ, Cox JL, Gupta M, Kertland H, Mehta SR, Welsh RC, Goodman SG. Assessment and Management of Acute Coronary Syndromes (ACS): A Canadian Perspective on Current Guideline-Recommended Treatment – Part 2: ST-Segment Elevation Myocardial Infarction. Can J Cardiol 2011; 27 Suppl A:S402-12. [DOI: 10.1016/j.cjca.2011.08.107] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 08/02/2011] [Accepted: 08/03/2011] [Indexed: 10/15/2022] Open
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126
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Comparison of one-year outcome of patients aged <75 years versus ≥75 years undergoing "rescue" percutaneous coronary intervention. Am J Cardiol 2011; 108:1075-80. [PMID: 21791331 DOI: 10.1016/j.amjcard.2011.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 05/31/2011] [Accepted: 06/02/2011] [Indexed: 11/20/2022]
Abstract
The influence of age on the clinical results after rescue angioplasty (percutaneous coronary intervention [PCI]) has been poorly investigated. In the present study, we evaluated the outcome of 514 consecutive patients undergoing rescue PCI who were divided into 2 groups according to age: <75 years (n = 469) and ≥75 years (n = 45). The primary end point of the study was the incidence of death at 1 year of follow-up. The secondary end point was the 1-year incidence of major cardiac adverse events (MACE) defined as a composite of death, recurrent acute myocardial infarction, and target vessel revascularization. The predictors of death and MACE at 1 year were also investigated. At 1 year of follow-up, the <75-year-old group had a significantly lower incidence of death (7% vs 24%, p = 0.0001) and MACE (14% vs 28%, p = 0.01) compared to the ≥75-year-old group. The Cox proportional hazards model identified age (adjusted hazard ratio 0.2665, 95% confidence interval 0.1285 to 0.5524, p = 0.0004), cardiogenic shock (hazard ratio 0.1057, 95% confidence interval 0.0528 to 0.2117, p <0.000001), Thrombolysis In Myocardial Infarction flow grade 2 to 3 after PCI versus 0 to 1 (hazard ratio 3.8380, 95% confidence interval 1.7781 to 8.2843, p = 0.0006), multi- versus single-vessel disease (hazard ratio 0.3716, 95% confidence interval 0.1896 to 0.7284, p = 0.0039) as independent predictors of survival at 1 year of follow-up. In conclusion, at 1 year of follow-up after rescue PCI, the patients aged ≥75 years had a greater incidence of death and MACE compared to patients aged <75 years. Age, cardiogenic shock, Thrombolysis In Myocardial Infarction flow grade 0-1 after PCI, and multivessel coronary disease were predictors of survival and freedom from MACE at 1 year of follow-up.
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127
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Sutton AGC. [Old drugs and late intervention - can we improve as the struggle for universal primary percutaneous coronary intervention continues?]. Rev Esp Cardiol 2011; 64:955-8. [PMID: 21945091 DOI: 10.1016/j.recesp.2011.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 06/28/2011] [Indexed: 11/27/2022]
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128
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Ruiz-Nodar JM, Feliu E, Sánchez-Quiñones J, Valencia-Martín J, García M, Pineda J, Martín P, Mainar V, Bordes P, Heras S, Quintanilla MA, Sogorb F. [Minimum salvaged myocardium after rescue percutaneous coronary intervention: quantification by cardiac magnetic resonance]. Rev Esp Cardiol 2011; 64:965-71. [PMID: 21784571 DOI: 10.1016/j.recesp.2011.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 04/28/2011] [Indexed: 02/01/2023]
Abstract
INTRODUCTION AND OBJECTIVES When fibrinolysis fails in patients with ST elevation myocardial infarction, they are referred for a rescue percutaneous coronary intervention (PCI). However, there is still no evidence of how much myocardium potentially at risk we can actually salvage after rescue PCI. METHODS Fifty consecutive patients. Cardiac magnetic resonance was performed within 6 days. Myocardial necrosis was defined by the extent of abnormal late enhancement, myocardium at risk by extent of edema, and the amount of salvaged myocardium by the difference between myocardium at risk and myocardial necrosis. Finally, myocardial salvage index (MSI) resulted from the fraction (area-at-risk minus infarct-size)/area-at-risk. RESULTS The mean time elapsed between pain onset and fibrinolitic agent administration was 176 ± 113 min; time lysis-rescue=PCI 209 ± 122 min; time pain onset-PCI = 390 ± 152 min. The area at risk was 37% ± 13% and infarct size 34.5% ± 13%. Salvaged myocardium was 3% ± 4% and MSI 9 ± 8. Salvaged myocardium and MSI were similar between patients with the artery open on arrival at the catheterization lab (Thrombolysis in Myocardial Infarction [TIMI] 3) and those with TIMI flow ≤ 2 (3.3% ± 3.6% and 8.2 ± 6.9 in TIMI 0-2 vs 3.0% ± 3.7% and 10.8 ± 10.9 in TIMI 3; P=.80 and 0.31, respectively). No significant difference was observed between patients who went through rescue PCI within a shorter time and those with longer delay times. CONCLUSIONS The myocardial salvage after rescue PCI quantified by cardiac magnetic resonance is very small. The long delay times between pain onset and the opening of the infarct-related artery with PCI are most probably the reason for such a minimal effect of rescue PCI.
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Affiliation(s)
- Juan M Ruiz-Nodar
- Departamento de Cardiología, Hospital General Universitario de Alicante, Alicante, España
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129
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von Scheidt W, Thilo C. As time goes by?: the fallacy of thrombolysis in STEMI networks. Clin Res Cardiol 2011; 100:867-77. [PMID: 21717207 DOI: 10.1007/s00392-011-0332-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 06/08/2011] [Indexed: 11/25/2022]
Abstract
Primary percutaneous coronary intervention (PPCI) is superior to thrombolysis (TL) as reperfusion therapy in ST-elevation myocardial infarction (STEMI). TL is a rapidly available, but semi-effective therapy (effective reperfusion in 50% of patients only), whereas PPCI is a potentially delayed, but highly effective therapy (effective reperfusion in >90%). Since TL loses its efficacy beyond 2-3 h after symptom onset, it is a significant reperfusion alternative to PPCI in early presenters only. The individual decision to treat an early presenter with PPCI or TL requires the evaluation of the time delay between potential start of TL or PPCI, the PCI-related delay (PRD). PRD is greatest, if TL is given in the prehospital setting. Until now, prehospital TL as the most rapidly available reperfusion strategy has failed to demonstrate any prognostic or even any other relevant benefit compared to PPCI in any subgroup of patients, even with time delays for PPCI of up to several hours. On average, a median PRD of at least 90-120 min can be considered a time corridor of prognostic superiority of PPCI over TL. This is already achieved in contemporary registries and myocardial infarction networks.Therefore, the efforts should not focus on the implementation of a dual reperfusion strategy (PPCI, and prehospital TL in selected cases) in established or upcoming myocardial infarction networks, but concentrate on the availability of PPCI in less than 2 h. TL, as rapid as possible, i.e. prehospital, is a vital treatment option in case of non-existing PPCI facilities within a median time limit of 2 h or even more, a scenario not existing or easily to eliminate in European countries by implementing well organized myocardial infarction networks. This is the mission to be accomplished.
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Affiliation(s)
- Wolfgang von Scheidt
- Department of Internal Medicine I, Klinikum Augsburg, Heart Center Augsburg-Swabia, Germany.
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130
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Kolh P, Wijns W. Joint ESC/EACTS guidelines on myocardial revascularization. J Cardiovasc Med (Hagerstown) 2011; 12:264-7. [PMID: 21372739 DOI: 10.2459/jcm.0b013e328344e647] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Guidelines for Myocardial Revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) are the very first reported consensus document, by a writing committee balanced between non-interventional and interventional cardiologists as well as cardiac surgeons, on this specific issue. Given the strong impact that ischaemic heart disease has on the survival and quality of life of the individual as well as the economic implications for society, the importance of the ESC/EACTS guidelines is obvious.
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Affiliation(s)
- Philippe Kolh
- Cardiovascular Surgery Department, University Hospital, CHU, ULg of Liege, Liege, Belgium.
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131
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Bogaty P, Filion KB, Brophy JM. Routine invasive management after fibrinolysis in patients with ST-elevation myocardial infarction: a systematic review of randomized clinical trials. BMC Cardiovasc Disord 2011; 11:34. [PMID: 21689449 PMCID: PMC3145591 DOI: 10.1186/1471-2261-11-34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 06/20/2011] [Indexed: 11/21/2022] Open
Abstract
Background Patients with ST-elevation myocardial infarction (STEMI) treated with fibrinolysis are increasingly, and ever earlier, referred for routine coronary angiography and where feasible, undergo percutaneous coronary intervention (PCI). We sought to examine the randomized clinical trials (RCTs) on which this approach is based. Methods We systematically searched EMBASE, Medline, and references of relevant studies. All contemporary RCTs (published since 1995) that compared systematic invasive management of STEMI patients after fibrinolysis with standard care were included. Relevant study design and clinical outcome data were extracted. Results Nine RCTs that randomized a total of 3320 patients were identified. All suggested a benefit from routine early invasive management. They were individually reviewed but important design variations precluded a formal quantitative meta-analysis. Importantly, several trials did not compare a routine practice of invasive management after fibrinolysis with a more selective 'ischemia-guided' approach but rather compared an early versus later routine invasive strategy. In the other studies, recourse to subsequent invasive management in the usual care group varied widely. Comparison of the effectiveness of a routine invasive approach to usual care was also limited by asymmetric use of a second anti-platelet agent, differing enzyme definitions of reinfarction occurring spontaneously versus as a complication of PCI, a preponderance of the 'soft' outcome of recurrent ischemia in the combined primary endpoint, and an interpretative bias when invasive procedures on follow-up were tallied as an endpoint without considering initial invasive procedures performed in the routine invasive arm. Conclusions Due to important methodological limitations, definitive RCT evidence in favor of routine invasive management following fibrinolysis in patients with STEMI is presently lacking.
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Affiliation(s)
- Peter Bogaty
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada.
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132
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Rosencher J, Bongard V, Tazarourte K, Soulat L, Savary D, Elbaz M, Miljkovic D, Cottin Y, Lambert Y, Steg PG, Puel J, Charpentier S. A simple nomogram for early prediction of myocardial reperfusion after pre-hospital thrombolysis. EUROINTERVENTION 2011; 7:248-55. [DOI: 10.4244/eijv7i2a40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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133
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Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, Koster RW, Wyllie J, Böttiger B. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 2011; 81:1219-76. [PMID: 20956052 DOI: 10.1016/j.resuscitation.2010.08.021] [Citation(s) in RCA: 847] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
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134
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Sánchez PL, Gimeno F, Ancillo P, Sanz JJ, Alonso-Briales JH, Bosa F, Santos I, Sanchis J, Bethencourt A, López-Messa J, de Prado AP, Alonso JJ, San Román JA, Fernández-Avilés F. Role of the paclitaxel-eluting stent and tirofiban in patients with ST-elevation myocardial infarction undergoing postfibrinolysis angioplasty: the GRACIA-3 randomized clinical trial. Circ Cardiovasc Interv 2011; 3:297-307. [PMID: 20716757 DOI: 10.1161/circinterventions.109.920868] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND A catheter-based approach after fibrinolysis is recommended if fibrinolysis is likely to be successful in patients with acute ST-elevation myocardial infarction. We designed a 2x2 randomized, open-label, multicenter trial to evaluate the efficacy and safety of the paclitaxel-eluting stent and tirofiban administered after fibrinolysis but before catheterization to optimize the results of this reperfusion strategy. METHODS AND RESULTS We randomly assigned 436 patients with acute ST-elevation myocardial infarction to (1) bare-metal stent without tirofiban, (2) bare-metal stent with tirofiban, (3) paclitaxel-eluting stent without tirofiban, and (4) paclitaxel-eluting stent with tirofiban. All patients were initially treated with tenecteplase and enoxaparin. Tirofiban was started 120 minutes after tenecteplase in those patients randomly assigned to tirofiban. Cardiac catheterization was performed within the first 3 to 12 hours after inclusion, and stenting (randomized paclitaxel or bare stent) was applied to the culprit artery. The primary objectives were the rate of in-segment binary restenosis of paclitaxel-eluting stent compared with that of bare-metal stent and the effect of tirofiban on epicardial and myocardial flow before and after mechanical revascularization. At 12 months, in-segment binary restenosis was similar between paclitaxel-eluting stent and bare-metal stent (10.1% versus 11.3%; relative risk, 1.06; 95% confidence interval, 0.74 to 1.52; P=0.89). However, late lumen loss (0.04+/-0.055 mm versus 0.27+/-0.057 mm, P=0.003) was reduced in the paclitaxel-eluting stent group. No evidence was found of any association between the use of tirofiban and any improvement in the epicardial and myocardial perfusion. Major bleeding was observed in 6.1% of patients receiving tirofiban and in 2.7% of patients not receiving it (relative risk, 2.22; 95% confidence interval, 0.86 to 5.73; P=0.14). CONCLUSIONS This trial does not provide evidence to support the use of tirofiban after fibrinolysis to improve epicardial and myocardial perfusion. Compared with bare-metal stent, paclitaxel-eluting stent significantly reduced late loss but appeared not to reduce in-segment binary restenosis. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov. Unique identifier: NCT00306228.
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Affiliation(s)
- Pedro L Sánchez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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135
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Rescue percutaneous coronary interventions for failed fibrinolytic therapy in ST-segment elevation myocardial infarction: a population-based study. Am Heart J 2011; 161:764-770.e1. [PMID: 21473977 DOI: 10.1016/j.ahj.2010.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 12/27/2010] [Indexed: 12/22/2022]
Abstract
BACKGROUND Fibrinolytic therapy remains the reperfusion strategy of choice for many regions treating patients presenting with ST-segment elevation myocardial infarction (STEMI). However, limited data exist regarding the pattern of use of rescue percutaneous coronary intervention (PCI) in patients with STEMI who failed fibrinolysis, factors associated with its use, and its impact on long-term outcomes. METHODS Observational analysis of a population-based cohort was done, which included 2,953 patients with STEMI hospitalized from 2004 to 2005 in Ontario, Canada. Failed fibrinolysis was defined as <50% ST-segment resolution on follow-up electrocardiogram at 60 to 90 minutes after fibrinolysis. The main outcome of measure was death or repeat hospitalization for acute coronary syndrome at 4 years. RESULTS Among the 1,517 patients who received fibrinolytic therapy, 611 patients (40.3%) failed fibrinolysis. Of these, rescue PCI was performed in 212 patients (34.7%); conservative management, in 373 patients (61.1%); and repeat fibrinolysis, in 26 patients (4.3%). Initial presentation to a PCI hospital was the strongest predictor of rescue PCI use (odds ratio 3.7, 95% CI 2.2-6.0). At 4-year follow-up, the primary end point occurred in 24.5% of patients who received rescue PCI and 36.5% in patients with no rescue PCI (adjusted hazard ratio 0.69, 95% CI 0.49-0.96). This difference was attributable mainly to a significant reduction in death favoring rescue PCI patients (hazard ratio 0.60, 95% CI 0.38-0.94). CONCLUSIONS Rescue PCI was associated with significantly lower risk of long-term adverse outcomes for patients with STEMI who failed fibrinolytic therapy. However, rescue PCI is substantially underused in clinical practice.
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136
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Sohal M, Foo F, Sirker A, Rajani R, Khawaja MZ, Pegge N, Hatrick R, Kneale B, Signy M, Holmberg S, de Belder A, Hildick-Smith D. Rescue angioplasty for failed fibrinolysis--long-term follow-up of a large cohort. Catheter Cardiovasc Interv 2011; 77:599-604. [PMID: 20824771 DOI: 10.1002/ccd.22771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 08/06/2010] [Indexed: 11/06/2022]
Abstract
BACKGROUND Fibrinolysis remains an important treatment for ST-elevation myocardial infarction, but fails to achieve adequate reperfusion in a significant proportion of cases. "Rescue" angioplasty is seen as the preferred treatment strategy in most contemporary centers although the literature provides conflicting evidence. METHODS We retrospectively reviewed all cases of rescue angioplasty performed at our cardiothoracic center from July 1999 to June 2008. The diagnosis of failed lysis was made on the basis of an ECG demonstrating failure of ST segment resolution >50% at 90 min. Periprocedural data was taken from a dedicated procedural database and mortality data obtained from the UK Office of National Statistics. RESULTS A total of 316 cases were performed. Patients were aged 61 ± 11 years. Thirty-day mortality was 8.9%. Thirty-day mortality in those presenting with cardiogenic shock was 50%, and in those requiring blood transfusion was also 50%. Thirty day mortality in those with TIMI III flow at the end of the procedure was significantly less than in those in whom this was not the case (6.6% vs. 23.3%; P < 0.001). One year mortality for the entire cohort was 10.1%. Longer-term follow-up revealed after 5.2 ± 2.3 years, survival in this cohort was 83%. Significant bleeding requiring blood transfusion occurred in 2.5% of cases. CONCLUSIONS We have shown that rescue angioplasty can be performed with good procedural success rates and excellent long-term results. Limiting bleeding complications and achieving TIMI III flow appear to be major determinants of achieving good long term results.
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Affiliation(s)
- Manav Sohal
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton and Sussex, UK
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137
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Wenzel V, Russo SG, Arntz HR, Bahr J, Baubin MA, Böttiger BW, Dirks B, Kreimeier U, Fries M, Eich C. [Comments on the 2010 guidelines on cardiopulmonary resuscitation of the European Resuscitation Council]. Anaesthesist 2011; 59:1105-23. [PMID: 21125214 DOI: 10.1007/s00101-010-1820-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
ADULTS Administer chest compressions (minimum 100/min, minimum 5 cm depth) at a ratio of 30:2 with ventilation (tidal volume 500-600 ml, inspiration time 1 s, F(I)O₂ if possible 1.0). Avoid any interruptions in chest compressions. After every single defibrillation attempt (initially biphasic 120-200 J, monophasic 360 J, subsequently with the respective highest energy), chest compressions are initiated again immediately for 2 min independent of the ECG rhythm. Tracheal intubation is the optimal method for securing the airway during resuscitation but should be performed only by experienced airway management providers. Laryngoscopy is performed during ongoing chest compressions; interruption of chest compressions for a maximum of 10 s to pass the tube through the vocal cords. Supraglottic airway devices are alternatives to tracheal intubation. Drug administration routes for adults and children: first choice i.v., second choice intraosseous (i.o.). Vasopressors: 1 mg epinephrine every 3-5 min i.v. After the third unsuccessful defibrillation amiodarone (300 mg i.v.), repetition (150 mg) possible. Sodium bicarbonate (50 ml 8.4%) only for excessive hyperkaliemia, metabolic acidosis, or intoxication with tricyclic antidepressants. Consider aminophylline (5 mg/kgBW). Thrombolysis during spontaneous circulation only for myocardial infarction or massive pulmonary embolism; during on-going cardiopulmonary resuscitation (CPR) only when indications of massive pulmonary embolism. Active compression-decompression (ACD-CPR) and inspiratory threshold valve (ITV-CPR) are not superior to good standard CPR. CHILDREN Most effective improvement of outcome by prevention of full cardiorespiratory arrest. Basic life support: initially five rescue breaths, followed by chest compressions (100-120/min depth about one third of chest diameter), compression-ventilation ratio 15:2. Foreign body airway obstruction with insufficient cough: alternate back blows and chest compressions (infants), or abdominal compressions (children >1 year). Treatment of potentially reversible causes: ("4 Hs and 4 Ts") hypoxia and hypovolaemia, hypokalaemia and hyperkalaemia, hypothermia, and tension pneumothorax, tamponade, toxic/therapeutic disturbances, thrombosis (coronary/pulmonary). Advanced life support: adrenaline (epinephrine) 10 µg/kgBW i.v. or i.o. every 3-5 min. Defibrillation (4 J/kgBW; monophasic or biphasic) followed by 2 min CPR, then ECG and pulse check. NEWBORNS: Initially inflate the lungs with bag-valve mask ventilation (p(AW) 20-40 cmH₂O). If heart rate remains <60/min, start chest compressions (120 chest compressions/min) and ventilation with a ratio 3:1. Maintain normothermia in preterm babies by covering them with foodgrade plastic wrap or similar. POSTRESUSCITATION PHASE: Early protocol-based intensive care stabilization; initiate mild hypothermia early regardless of initial cardiac rhythm [32-34°C for 12-24 h (adults) or 24 h (children); slow rewarming (<0.5°C/h)]. Consider percutaneous coronary intervention (PCI) in patients with presumed cardiac ischemia. Prediction of CPR outcome is not possible at the scene, determine neurological outcome <72 h after cardiac arrest with somatosensory evoked potentials, biochemical tests and neurological examination. ACUTE CORONARY SYNDROME: Even if only a weak suspicion of an acute coronary syndrome is present, record a prehospital 12-lead ECG. In parallel to pain therapy, administer aspirin (160-325 mg p.o. or i.v.) and clopidogrel (75-600 mg depending on strategy); in ST-elevation myocardial infarction (STEMI) and planned PCI also prasugrel (60 mg p.o.). Antithrombins, such as heparin (60 IU/kgBW, max. 4000 IU), enoxaparin, bivalirudin or fondaparinux depending on the diagnosis (STEMI or non-STEMI-ACS) and the planned therapeutic strategy. In STEMI define reperfusion strategy depending on duration of symptoms until PCI, age and location of infarction. TRAUMA: In severe hemorrhagic shock, definitive control of bleeding is the most important goal. For successful CPR of trauma patients a minimal intravascular volume status and management of hypoxia are essential. Aggressive fluid resuscitation, hyperventilation and excessive ventilation pressure may impair outcome in patients with severe hemorrhagic shock. TRAINING Any CPR training is better than nothing; simplification of contents and processes is the main aim.
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Affiliation(s)
- V Wenzel
- Univ.-Klinik für Anaesthesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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De Felice F, Fiorilli R, Parma A, Musto C, Nazzaro MS, Stefanini GG, Caferri G, Violini R. Comparison of one-year cardiac events with drug-eluting versus bare metal stent implantation in rescue coronary angioplasty. Am J Cardiol 2011; 107:210-4. [PMID: 21129713 DOI: 10.1016/j.amjcard.2010.08.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 08/29/2010] [Accepted: 08/31/2010] [Indexed: 10/18/2022]
Abstract
Rescue percutaneous coronary intervention (PCI) with bare metal stent (BMS) implantation is useful in patients with acute myocardial infarction (AMI) and failed thrombolysis. Drug-eluting stent (DESs) are more effective in reducing restenosis compared to BMS. No data are available comparing the clinical outcomes between the 2 types of stents nor has information ever been provided about the predictors of events in patients treated with rescue PCI in the current era. The aims of the present study were to evaluate the outcomes of patients undergoing rescue PCI with DES implantation compared to BMS implantation and to determine the independent predictors of events during 1 year of follow-up. The study population consisted of 311 consecutive patients with ST-segment elevation AMI and evidence of failed fibrinolysis undergoing successful revascularization with DES (n = 134) or BMS (n = 177) implantation. The end point of the present study was the incidence of major adverse cardiac events (MACE) defined as death, recurrent AMI, and target vessel revascularization. No differences were found in the number of MACE at 1 year of follow-up between the DES and BMS groups (n = 10 and 19, respectively, p = 0.29). The Cox proportional hazards model identified cardiogenic shock (adjusted hazard ratio 7.05, 95% confidence interval 2.08 to 23.9, p = 0.001), age (hazard ratio 1.51, 95% CI 1.09 to 2.08, p = 0.011), and final minimal lumen diameter (hazard ratio 0.42, 95% confidence interval 0.21 to 0.83, p = 0.013) as independent predictors of MACE at 1 year of follow-up. After propensity score adjustments, the predictors did not change. In conclusion, we found no differences between DESs and BMSs with respect to MACE at 1 year of follow-up in patients with AMI treated with rescue PCI. Cardiogenic shock, age, and final minimal luminal diameter were identified as predictors of MACE.
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139
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Burjonroppa SC, Varosy PD, Rao SV, Ou FS, Roe M, Peterson E, Singh M, Shunk KA. Survival of Patients Undergoing Rescue Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2011; 4:42-50. [DOI: 10.1016/j.jcin.2010.09.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 08/02/2010] [Accepted: 09/17/2010] [Indexed: 10/18/2022]
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140
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Aubry P, Halna du Fretay X. [Antithrombotic treatments in acute coronary syndromes with persistent ST-segment elevation]. Ann Cardiol Angeiol (Paris) 2010; 59:335-343. [PMID: 21056405 DOI: 10.1016/j.ancard.2010.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Pharmacological treatment is essential to limit myocardial damages of occluding thrombus feature of acute coronary syndromes with persistent ST-segment elevation. Thanks to its ease of use, it will always come first and accompany a mechanical treatment that will complement its action. Research has been very active in the last few years allowing the development of new agents, mostly oral antiplatelets and intravenous or subcutaneous antithrombins. Physicians implied in strategies of reperfusion have a responsibility to choose the most suitable combination therapy taking into account delays in care, kind of reperfusion and the patient himself. The highest level of recommendation indicative of a perfect agreement of the experts is rare in this area. Therefore, guidance is needed to help physicians. Admittedly the latest European recommendations merit of having taken positions often clear when several molecules are available in the same indication. They also underline the arrival, unexpected a few years ago, of oral treatment with rapid onset and efficacy perfectly suited to start an emergency antithrombotic treatment in acute coronary syndromes with persistent ST-segment elevation. Nevertheless, progress in terms of clinical efficacy is often modest, requiring a concomitant evaluation of each new molecule's safety, particularly the risks of bleeding.
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Affiliation(s)
- P Aubry
- Département de cardiologie, centre hospitalier Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, France.
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141
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Arntz HR, Bossaert L, Danchin N, Nicolau N. Initiales Management des akuten Koronarsyndroms. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1371-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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142
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Hassan A, Newman A, Ko DT, Rinfret S, Hirsch G, Ghali WA, Tu JV. Increasing rates of angioplasty versus bypass surgery in Canada, 1994-2005. Am Heart J 2010; 160:958-65. [PMID: 21095286 DOI: 10.1016/j.ahj.2010.06.052] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Accepted: 06/14/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is increasingly being offered to patients with coronary artery disease. The purpose of this study was to determine the impact of this change in coronary revascularization strategy on PCI and coronary artery bypass grafting (CABG) utilization across Canada. METHODS All cases of PCI and isolated CABG between years 1994 and 2005 were identified through the Canadian Institute for Health Information. Age- and sex-standardized rates of PCI and CABG per 100,000 population as well as PCI-to-CABG ratios were calculated by year and province and across age, sex, income, diabetes, and recent acute coronary syndrome subgroups. In addition, risk-adjusted rates of in-hospital mortality after PCI and CABG were reported by year. RESULTS Between 1994 and 2005, PCI rates increased from 85.6/100,000 to 186.7/100,000 (P < .001), whereas CABG rates remained stable (75.6/100,000-70.8/100,000; P = .43), resulting in an increase in PCI-to-CABG ratio (1.13-2.64; P < .001). Significant increases in PCI-to-CABG ratios were seen across all provinces (except Newfoundland and Alberta), as well as across all age, sex, income, diabetes, and recent acute coronary syndrome categories. Decline in risk-adjusted in-hospital mortality was seen after both CABG (3.9%-2.2%; P < .001) and PCI (1.6%-1.3%; P < .001) but appeared larger after CABG. CONCLUSIONS Since 1994, rates of PCI have increased significantly as compared to CABG. During the same period, greater declines in risk-adjusted rates of in-hospital mortality were seen among CABG versus PCI patients. Further study is needed to determine the appropriateness of PCI and CABG rates in terms of clinical outcomes and resource utilization.
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Affiliation(s)
- Ansar Hassan
- Department of Cardiac Surgery, New Brunswick Heart Center, Saint John, New Brunswick, Canada.
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143
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Does ST resolution achieved via different reperfusion strategies (fibrinolysis vs percutaneous coronary intervention) have different prognostic meaning in ST-elevation myocardial infarction? A systematic review. Am Heart J 2010; 160:842-848.e1-2. [PMID: 21095270 DOI: 10.1016/j.ahj.2010.06.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 06/29/2010] [Indexed: 12/22/2022]
Abstract
OBJECTIVE We perform a systematic review to discern if ST resolution achieved via percutaneous coronary intervention (PCI) has a different meaning to that achieved via fibrinolysis. BACKGROUND Resolution of ST-segment elevation in acute myocardial infarction has been widely used as a surrogate for treatment success. A recent randomized study suggested that after primary PCI, the prognostic significance of ST resolution may have been overemphasized. METHODS Using the MEDLINE, COCHRANE, EMBASE, and PUBMED databases to search for the relevant papers, we analyze the data with a new ST-resolution score. ST-resolution groups of <30%, 30% to < 70%, and ≥ 70% are given scores of 1, 2, and 3 respectively, whereas ST-resolution groups reported as < 50% are scored as 1.5, and ≥ 50% scored as 2.5. RESULTS We identify 18 fibrinolysis cohorts (32,341 patients) and 5 PCI cohorts (1,913 patients). The mean ST-resolution score weighted for the number of patients in each cohort is 1.87 ± 0.15 for PCI and 1.66 ± 0.20 for fibrinolysis (P < .001). The raw combined 30-day mortality is 4.9% with fibrinolysis and 4.3% with PCI (P = .452 by Poisson regression). There is a linear relationship with lower 30-day mortality associated with higher ST-resolution score. The regression line for the PCI cohorts almost overlaps with that from the fibrinolysis cohorts. On multivariate regression, only ST-resolution score is significant in predicting 30-day mortality. When tested, the interaction term (treatment group × ST resolution score) is never a significant predictor (P > .25 in all models). CONCLUSION ST resolution after different reperfusion therapies has similar prognostic meaning.
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Arntz HR, Bossaert LL, Danchin N, Nikolaou NI. European Resuscitation Council Guidelines for Resuscitation 2010 Section 5. Initial management of acute coronary syndromes. Resuscitation 2010; 81:1353-63. [DOI: 10.1016/j.resuscitation.2010.08.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Beltesbrekke HS, Husa MB, Vik-Mo H. [Acute myocardial infarction in Mid-Norway: transportation for thrombolytic treatment or primary percutaneous coronary intervention?]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2010; 130:1714-6. [PMID: 20835281 DOI: 10.4045/tidsskr.09.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Occluded coronary arteries should be opened urgently in patients who have acute myocardial infarction and ST-elevation in ECG. When transport times are long, thrombolytic treatment is a good alternative to primary percutaneous coronary intervention (PCI). The purpose of this study was to assess choice of treatment strategy in cases where time after start of symptoms and transport time are decisive for the outcome. MATERIAL AND METHODS A cohort study of 379 patients, who had myocardial infarction and ST-elevation, and were admitted to St. Olav's Hospital, Trondheim, Norway in the period 1.11.2007-31.1.2009. RESULTS 268 patients (71 %) were treated with PCI, and 111 patients (29 %) with thrombolytic treatment. 173 patients (46 %) were transported by helicopter. The counties in Mid-Norway used markedly different treatment strategies for these patients. INTERPRETATION Great regional differences were observed in the use of PCI and thrombolytic treatment in Mid-Norway.
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Affiliation(s)
- Hanne Saettem Beltesbrekke
- Institutt for sirkulasjon og bildediagnostikk, Norges teknisk-naturvitenskapelige universitet og Hjertemedisinsk avdeling, St. Olavs hospital, 7006 Trondheim, Norway
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Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, Garg S, Huber K, James S, Knuuti J, Lopez-Sendon J, Marco J, Menicanti L, Ostojic M, Piepoli MF, Pirlet C, Pomar JL, Reifart N, Ribichini FL, Schalij MJ, Sergeant P, Serruys PW, Silber S, Sousa Uva M, Taggart D. Guidelines on myocardial revascularization. Eur Heart J 2010; 31:2501-55. [PMID: 20802248 DOI: 10.1093/eurheartj/ehq277] [Citation(s) in RCA: 1697] [Impact Index Per Article: 121.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
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- Cardiovascular Center, OLV Ziekenhuis, Moorselbaan 164, 9300 Aalst, Belgium.
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PÉREZ-BERBEL PATRICIO, VALENCIA JOSÉ, RUIZ-NODAR JUANMIGUEL, PINEDA JAVIER, BORDES PASCUAL, MAINAR VICENTE, SOGORB FRANCISCO. Rescue Angioplasty: Characteristics and Results in a Single-Center Experience. J Interv Cardiol 2010; 24:42-8. [DOI: 10.1111/j.1540-8183.2010.00595.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sauer R, Huttner HB, Breuer L, Engelhorn T, Schellinger PD, Schwab S, Köhrmann M. Repeated Thrombolysis for Chronologically Separated Ischemic Strokes. Stroke 2010; 41:1829-32. [DOI: 10.1161/strokeaha.110.585067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Roland Sauer
- From the Departments of Neurology (R.S., H.B.H., L.B., P.D.S., S.S., M.K.) and Neuroradiology (T.E.), University of Erlangen-Nuremberg, Germany
| | - Hagen B. Huttner
- From the Departments of Neurology (R.S., H.B.H., L.B., P.D.S., S.S., M.K.) and Neuroradiology (T.E.), University of Erlangen-Nuremberg, Germany
| | - Lorenz Breuer
- From the Departments of Neurology (R.S., H.B.H., L.B., P.D.S., S.S., M.K.) and Neuroradiology (T.E.), University of Erlangen-Nuremberg, Germany
| | - Tobias Engelhorn
- From the Departments of Neurology (R.S., H.B.H., L.B., P.D.S., S.S., M.K.) and Neuroradiology (T.E.), University of Erlangen-Nuremberg, Germany
| | - Peter D. Schellinger
- From the Departments of Neurology (R.S., H.B.H., L.B., P.D.S., S.S., M.K.) and Neuroradiology (T.E.), University of Erlangen-Nuremberg, Germany
| | - Stefan Schwab
- From the Departments of Neurology (R.S., H.B.H., L.B., P.D.S., S.S., M.K.) and Neuroradiology (T.E.), University of Erlangen-Nuremberg, Germany
| | - Martin Köhrmann
- From the Departments of Neurology (R.S., H.B.H., L.B., P.D.S., S.S., M.K.) and Neuroradiology (T.E.), University of Erlangen-Nuremberg, Germany
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Borgia F, Goodman SG, Halvorsen S, Cantor WJ, Piscione F, Le May MR, Fernández-Avilés F, Sánchez PL, Dimopoulos K, Scheller B, Armstrong PW, Di Mario C. Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation myocardial infarction: a meta-analysis. Eur Heart J 2010; 31:2156-69. [PMID: 20601393 DOI: 10.1093/eurheartj/ehq204] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS Multiple trials in patients with ST-segment elevation myocardial infarction (STEMI) compared early routine percutaneous coronary intervention (PCI) after successful fibrinolysis vs. standard therapy limiting PCI only to patients without evidence of reperfusion (rescue PCI). These trials suggest that all patients receiving fibrinolysis should receive mechanical revascularization within 24 h from initial hospitalization. However, individual trials could not demonstrate a significant reduction in 'hard' endpoints such as death and reinfarction. We performed a meta-analysis of randomized controlled trials to define the benefits of early PCI after fibrinolysis over standard therapy on clinical and safety endpoints in STEMI. METHODS AND RESULTS We identified seven eligible trials, enrolling a total of 2961 patients. No difference was found in the incidence of death at 30 days between the two strategies. Early PCI after successful fibrinolysis reduced the rate of reinfarction (OR: 0.55, 95% CI: 0.36-0.82; P = 0.003), the combined endpoint death/reinfarction (OR: 0.65, 95% CI: 0.49-0.88; P = 0.004) and recurrent ischaemia (OR: 0.25, 95% CI: 0.13-0.49; P < 0.001) at 30-day follow-up. These advantages were achieved without a significant increase in major bleeding (OR: 0.93, 96% CI: 0.67-1.34; P = 0.70) or stroke (OR: 0.63, 95% CI: 0.31-1.26; P = 0.21). The benefits of a routine invasive strategy over standard therapy were maintained at 6-12 months, with persistent significant reduction in the endpoints reinfarction (OR: 0.64, 95% CI: 0.40-0.98; P = 0.01) and combined death/reinfarction (OR: 0.71, 95% CI: 0.52-0.97; P = 0.03). CONCLUSION Early routine PCI after fibrinolysis in STEMI patients significantly reduced reinfarction and recurrent ischaemia at 1 month, with no significant increase in adverse bleeding events compared to standard therapy. Benefits of early PCI persist at 6-12 month follow-up.
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Tubaro M. An organized system of emergency care for patients with myocardial infarction: a reality? Future Cardiol 2010; 6:483-9. [DOI: 10.2217/fca.10.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An organized system of emergency care is an essential requirement for the modern treatment of ST-elevation acute myocardial infarction. There is a strong need to deliver reperfusion therapy as soon as possible, with primary percutaneous coronary intervention being the preferred option if performed in a timely manner and thrombolytic therapy, particularly in the prehospital setting, being a good alternative if the primary percutaneous coronary intervention-related delay exceeds the equipoise. In this situation, emergency medical services have a primary role in rescuing patients from cardiac arrest, performing prehospital diagnosis, triage and treatment and safely transporting them to the most appropriate cardiological center, including interhospital transfer. A complete reorganization of the healthcare systems in different countries is frequently needed to build an ST-elevation acute myocardial infarction system of care, focusing on fast transport, use of telemedicine and diversion protocols to skip the unsuited centers.
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Affiliation(s)
- Marco Tubaro
- Cardiovascular Department, San Filippo Neri Hospital, Rome, Italy
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