Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction

Scheller, Bruno; Hennen, Benno; Hammer, B; Walle, J. P. Van De; Höfer, Christian; Hilpert, Volker; Winter, H.; Nickenig, Georg; Böhm, Michael

doi:10.1016/s0735-1097(03)00763-0

Cited by 205 publications

(72 citation statements)

References 21 publications

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“…The outcomes were in keeping with studies in which thrombolysis was followed by frequent revascularization [2, 23,37,38,39,40,41] and suggest that the advantage of PPCI may be attenuated in this setting. The findings are especially relevant for the large number of centers where immediate angiography-intervention facilities are not always available or readily applicable [28].…”

Section: Discussionsupporting

confidence: 80%

“…A meta-analysis revealed a reduction in severe heart failure and improved survival in patients with moderate or large STEMI [33], as did the randomized UK REACT trial [34]. Although studies in the pre-stent and pre-drug eluting stent era and prior to the availability of effective anti-platelet therapy did not support routine revascularization following thrombolysis [35, 36], recent randomized trials did support an invasive approach [37,38,39]. …”

Section: Discussionmentioning

confidence: 99%

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Thrombolysis Followed by Early Revascularization: An Effective Reperfusion Strategy in Real World Patients with ST-Elevation Myocardial Infarction

Jaffe

Halon²,

Karkabi³

et al. 2007

Cardiology

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Background: Several trials suggested superiority of primary percutaneous coronary intervention (PPCI) angioplasty over thrombolysis in patients with ST-elevation myocardial infarction (STEMI), but many trials were characterized by low rates of early revascularization in patients treated with initial thrombolysis. We tested the hypothesis that in patients with hemodynamically stable STEMI, initial thrombolysis followed by an active early rescue/definitive revascularization strategy could achieve salutary short- and long-term outcomes. Methods: A prospective registry documented all 212 STEMI patients who received initial thrombolytic therapy over a 2-year period in a single medical center. Median patient age was 58 (range: 29–92) years, 47 (22%) patients were aged >70 years and 18 (8%) >80 years. Fifty-two (25%) patients underwent rescue angioplasty <6 h after thrombolysis for inadequate clinical reperfusion. In 194/212 (92%) patients, coronary angiography was performed during initial hospitalization, PCI in 168 (79%), and coronary bypass surgery in 18 (8%). Results: Thirty-day mortality was 4.7% and 1-year mortality 6.7%. Mortality was not related to diabetes mellitus, hypertension, anterior infarction location, fibrin-specific thrombolytic drug or rescue PCI. By multivariate analysis, in-hospital definitive angiography/revascularization (p < 0.0001) and TIMI risk score >3 on admission (p < 0.01) were significant independent predictors of both 30 day and 12 month outcome. Conclusions: Initial thrombolysis was useful and effective in real-world STEMI patients when coupled with an aggressive policy of rescue angioplasty and early in-hospital revascularization. Outcomes compared favorably with those reported for PPCI trials. The adverse prognosis in older patients with higher TIMI risk score suggests that in those patients alternative initial treatment strategies such as PPCI should be considered.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Thrombolysis Followed by Early Revascularization: An Effective Reperfusion Strategy in Real World Patients with ST-Elevation Myocardial Infarction

Jaffe

Halon²,

Karkabi³

et al. 2007

Cardiology

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“…One of the earliest trials looking at the association was SIAM III done on 197 patients with AMI where one group received angioplasty within six hours of thrombolysis with reteplase and the other after two weeks. It was found that the immediate stenting group had a significant decrease in primary endpoint of ischemic event, death, reinfarction and need for revascularization by 25% [20]. GRACIA 1 is another randomized intent to treat trial, which compared combined endpoints of death, reinfarction and revascularization at 12 months.…”

Section: Role Of Pci In Post Thrombolysis Stable Patientsmentioning

confidence: 99%

PCI in Post Thrombolysis Stable STEMI Patients: A Timeline in Question

Hasan¹,

Rashid²,

Bhuiyan³

2015

WJCD

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ST elevation myocardial infarction (STEMI) occupies a significant portion of the cardiovascular disease spectrum and poses a continuing challenge on the health care delivery system worldwide. A dilemma exists in the clinical triage system for appropriate strategic modalities of treatment, based on underlying triad of patient-hospital-cardiac pathological factors as well as cut off timelines. Current European Society of Cardiology (ESC) guideline recommends percutaneous coronary intervention (PCI) within 3 to 24 hours in post thrombolysis stable patients. This review critically evaluated the evidences underlying the ESC recommendation. Trials included in this review are SIAM III, GRACIA 1, CAPITAL-AMI, CARESS-IN-AMI, NORDISTEMI, PRAGUE-1, WEST and LEIPZIG. Most of the evidences support the notion for immediate post thrombolysis PCI in stable patients within 1.9 to 2.7 hours, which contradicts the ESC timeline of up to 24 hours. Also, there is a reduced generalizability of the trial results due to differences in the design of the various trials, study population, composite endpoints, variations in drug dose & formulation, co-administration of pharmacotherapies and type of stents used. This warrants further research for standardization & optimization of the treatment protocol with respect to post thrombolysis PCI in stable STEMI patients.

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“…Diese Empfehlung wurde auf der Stufe I A gegeben und basierte vor allem auf den SIAM-III- [7], GRACIA-1- [8] und CAPITAL-AMI-Studien [9] im Zusammenhang mit den LPLS- [10] und ALKK-Studien [11] sowie AS-SENT-2 [12] und der Metaanalyse der TIMI-4-, -9-und -10b-sowie der IN-TIME-II-Studien [13]. …”

Section: Kommentarunclassified

Die ESC-Leitlinien zur perkutanen Koronarintervention (PCI)

Silber

Richartz

Brilmayer

2006

Herz

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The European Society of Cardiology (ESC) for the first time issued guidelines for percutaneous coronary interventions (PCI) in spring 2005. The strengths of recommendations stated in the ESC guidelines (as in those of the AHA/ACC [American Heart Association/American College of Cardiology]) are traditionally a combination of recommendation classes (I, IIa, and IIb) and a level of evidence (A, B, or C). This paper explains and discusses selected focal points of the ESC PCI guidelines based on three representative cases from daily practice. 1. Stable coronary artery disease (CAD): PCI in a 53-year-old patient without angina pectoris and proof of myocardial ischemia. With a clear indication of ischemia in the anterior myocardial wall, the ESC PCI guidelines indicated coronary angiography with possible PCI, even without angina pectoris symptoms. Cardiac catheterization showed a 99% proximal LAD stenosis, which was immediately dilated and stented based on the indicated ischemia. According to the ESC PCI guidelines, an intervention is indicated for CAD when a larger ischemic area is clearly evident even in the absence of typical angina (recommendation class I A). 2. ST segment elevation myocardial infarction (STEMI): PCI even after successful thrombolysis. A 70-year-old patient experienced acute substernal pain and immediately went to his nearby hospital. The ECG clearly showed anterior myocardial wall STEMI, which in this hospital without a cardiac cath lab indicated thrombolysis, since it could be initiated within 3 h after the onset of chest pain. Pain relief was evident soon after thrombolysis, combined with a resolution of the ST segment elevations. As suggested by the ESC PCI guidelines, a transfer to a cardiac cath lab took place the next day, where the 50% residual stenosis of the LAD was stented. The ESC PCI guidelines suggest coronary angiography with possible PCI within 1-2 days following successful thrombolysis (recommendation class I A). Thus, even "successful" thrombolysis is not regarded as the final treatment for STEMI. 3. Premature termination of clopidogrel after stent implantation: stent thrombosis with acute myocardial infarction. A 46-year-old patient visited the practice due to increasing dyspnea. 4 months earlier, a Taxus stent had been implanted at a heart center into the second RPLS of the RCX; 3 days later, a Cypher stent was implanted in the LAD. Upon being discharged on a Friday at noon, the patient was advised to see his general practitioner soon to attain a prescription for clopidogrel. The patient was given an appointment at his general practitioner for the following Wednesday afternoon. But on that Wednesday morning the patient went into cardiogenic shock. Although the occluded LAD (stent thrombosis) could be quickly reopened, left ventricular myocardium became severely damaged. Until a cardiac transplantation will be performed, a defibrillator was implanted. This "organizational" gap in clopidogrel administration did not conform to the ESC PCI guidelines: after implantation of any corona...

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Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction

Abstract: Immediate stenting after thrombolysis leads to a significant reduction of cardiac events compared with a more conservative approach including delayed stenting after two weeks.

Cited by 205 publications

References 21 publications

Thrombolysis Followed by Early Revascularization: An Effective Reperfusion Strategy in Real World Patients with ST-Elevation Myocardial Infarction

Thrombolysis Followed by Early Revascularization: An Effective Reperfusion Strategy in Real World Patients with ST-Elevation Myocardial Infarction

PCI in Post Thrombolysis Stable STEMI Patients: A Timeline in Question

Die ESC-Leitlinien zur perkutanen Koronarintervention (PCI)

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