Comparison of pre-hospital combination-fibrinolysis plus conventional care with pre-hospital combination-fibrinolysis plus facilitated percutaneous coronary intervention in acute myocardial infarction

Thiele, Holger; Engelmann, L.; Elsner, Kathleen; Kappl, Mathias J.; Storch, W.-H.; Rahimi, Kazem; Hartmann, Andreas; Pfeiffer, Dietrich; Kneissl, Georg Dieter; Schneider, Dietrich; Möller, Thomas; Heberling, Hans J.; Weise, I; Schuler, Gerhard

doi:10.1093/eurheartj/ehi432

Cited by 84 publications

(55 citation statements)

References 36 publications

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“…Twelve larger randomized studies and metaanalyses (LOE 1) 438 -449 and 2 smaller randomized studies 450,451 consistently reported better clinical outcome with use of glycoprotein IIb/IIIa inhibitors compared with placebo. This result was supported by many studies which consistently reported better outcomes with upstream or early use of glycoprotein IIb/IIIa inhibitor compared with deferred treatment or other strategies (LOE 1 [452][453][454][455][456][457][458][459][460][461][462][463][464][465][466][467] ; LOE 2 468 -473 ; LOE 3 474 ; LOE 4 [475][476][477][478] ; LOE 5 479 ).…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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“…In a recent comparative study of ST-segment resolution by thrombolytic versus primary coronary intervention (PCI), showed the resolution of ST-segment by thrombolytic are as follows: Complete 51.9%, partial 26.6% and failed resolution in 21.5% acute myocardial infarction patients after 90 min of initiation of fibrinolytic therapy (Thiele et al, 2005). By using the same resolution criteria, in our study we observed the similar results in non-diabetic myocardial infarction where 48.4% patients showed complete resolution, 31.7% patient's partial resolution and 19.8% showed failed In our study, more 'complete ST-resolution' was seen in non-diabetic patient (48.4 vs. 19.7%; Z= 4.25; p<0.001) whereas type 2 diabetic subjects were presented with significantly higher incidence of failed ST-resolution than non-diabetic subjects (67.2 vs. 19.8%; Z= 6.79; p<0.001).…”

Section: Discussionmentioning

confidence: 99%

A comparative study on the effect of streptokinase between diabetic and non-diabetic myocardial infarction patients

Chowdhury

Hossain

Dey

et al. 2008

Bangladesh J Pharmacol

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A prospective interventional study was carried out to compare the thrombolytic effect of streptokinase between diabetic and non-diabetic myocardial infarction patients. Out of 187 study subjects with acute ST segment elevation myocardial infarction, admitted at coronary care unit, 126 patients were nondiabetic and 61 patients were diabetic. Streptokinase was administered to all patients. Resolution (reduction) of elevated ST segment was evaluated after 90 min of streptokinase administration. Successful reperfusion (≥70% ST-resolution) was significantly higher in non-diabetic than diabetic (p<0.001), while failed reperfusion (<30% ST resolution) was significantly higher in diabetic patients (p<0.001). It may be concluded that diabetes mellitus might affect the thrombolytic outcome of acute myocardial infarction patients with diabetes mellitus.

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“…The Leipzig Prehospital Fibrinolysis Group randomized 164 patients within 6 hours of STEMI onset in the prehospital setting to reteplase plus abciximab alone or reteplase plus abciximab and transfer for immediate PCI. 24 The primary end point of infarct size assessed by delayed-enhancement magnetic resonance was reduced in the immediate PCI arm (median, 5.2% versus 10.4%; Pϭ0.001), and the composite clinical end point of death, reinfarction, major bleeding, or stroke at 6 months tended to be reduced with immediate PCI compared with fibrinolysis alone (15% versus 25%; Pϭ0.10). In the Combined Angioplasty and Pharmacological Intervention Versus Thrombolysis Alone in Acute Myocardial Infarction (CAPITAL AMI) trial, 170 STEMI patients treated with tenecteplase within 6 hours of symptom onset were randomized to routine immediate PCI or conservative care with rescue or deferred PCI as clinically indicated.…”

Section: Fibrinolysis With Versus Without Immediate Routine Pcimentioning

confidence: 99%

“…16,20 In contrast to these historical studies, 7 contemporary prospective, modest-sized randomized trials have been published and collectively demonstrate that routine PCI with stent implantation in the early hours after fibrinolysis may be beneficial compared with a strategy of delayed routine or ischemia-driven PCI. [22][23][24][25][26][27][28] In the Primary Angioplasty in Patients Transferred From General Community Hospitals to Specialized PTCA Units With or Without Emergency Thrombosis (PRAGUE) trial, 300 patients within 6 hours of STEMI onset were randomized at hospitals without PCI facilities to streptokinase alone, streptokinase plus transfer for immediate PCI, or transfer for primary PCI. 22 Figure 1.…”

Section: Fibrinolysis With Versus Without Immediate Routine Pcimentioning

confidence: 99%

“…Data are at the time of latest follow-up (3 months from the PRAGUE, WEST, CARESS, and Leipzig trials; 6 months from the CAPITAL-AMI and SIAM-III trials; and 1 year from the GRACIA-1 trial). [22][23][24][25][26][27][28] and randomized to urgent transfer to a tertiary center for catheterization and PCI within 6 hours (the "pharmacoinvasive strategy") or to transfer for elective catheterization within several days unless urgent transfer was required for rescue PCI for failed reperfusion ("standard therapy"). 29 PCI was performed in 84% of patients in the pharmacoinvasive arm at a median time of 3 hours after tenecteplase versus in 62% of standard therapy patients at a median time of 27 hours after tenecteplase.…”

Section: Fibrinolysis With Versus Without Immediate Routine Pcimentioning

confidence: 99%

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Angioplasty Strategies in ST-Segment–Elevation Myocardial Infarction

Stone

2008

Circulation

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A s reviewed in part I of this report, 1 primary PCI without antecedent fibrinolytic therapy has become widely accepted as the preferred reperfusion modality for patients with ST-segment-elevation myocardial infarction (STEMI) presenting at suitably equipped tertiary facilities. However, primary percutaneous coronary intervention (PCI) is not offered at Ն50% of US hospitals, and many of those that do are unable to offer primary PCI as an around-the-clock service. Primary PCI also is less widely available in many other countries than in the United States. Thus, fibrinolytic therapy continues to be administered to many patients with STEMI. 2,3 Given the relatively low rates of successful reperfusion with fibrinolysis, 4,5 revascularization often is required afterward, the indications for and outcomes of which are critically evaluated here. The impact of individual operator and institutional volumes on PCI outcomes is reviewed. Evidencebased recommendations for selecting among the various reperfusion therapy options are then offered for the patients with STEMI presenting at centers with and without interventional capabilities, with distinctions drawn where the evidence-based recommendations in this article differ substantially from recently updated task force guidelines of the American College of Cardiology (ACC) and American Heart Association (AHA). 5 Finally, recent and ongoing investigations to further improve outcomes after catheter-based reperfusion therapy are summarized. Angioplasty After Fibrinolytic TherapyPCI after fibrinolytic therapy in STEMI may be performed in a variety of settings: (1) rescue PCI after failed fibrinolysis in patients with ongoing symptoms, myocardial injury, or persistent coronary occlusion, typically initiated within 60 to 120 minutes after fibrinolytic administration; (2) immediate PCI (also known as facilitated PCI), performed within several hours after fibrinolytic administration, regardless of whether clinical or ECG evidence of ongoing myocardial injury is present; (3) delayed routine PCI, in which patients who are stable for several days after fibrinolytic administration undergo angiography and PCI, regardless of the presence or absence of ischemia or myocardial viability; and (4) delayed selective angioplasty, in which only patients with spontaneous or inducible ischemia after fibrinolysis undergo catheterization and PCI when appropriate.Similar to primary PCI, each of these interventional strategies describes an approach of angiography followed by triage to angioplasty, coronary artery bypass graft surgery, or medical therapy, a decision based on the coronary anatomy, left ventricular function, and other patient-related factors. However, PCI is performed in Ϸ80% to 90% of angiographically screened patients requiring revascularization. Rescue PCIRescue PCI refers to the strategy of urgent catheterization after fibrinolytic therapy has clinically failed to restore reperfusion of the infarct artery. Patients in whom fibrinolysis fails to restore patency of the infarct-related a...

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Comparison of pre-hospital combination-fibrinolysis plus conventional care with pre-hospital combination-fibrinolysis plus facilitated percutaneous coronary intervention in acute myocardial infarction

Cited by 84 publications

References 36 publications

Part 9: Acute Coronary Syndromes

Part 9: Acute Coronary Syndromes

A comparative study on the effect of streptokinase between diabetic and non-diabetic myocardial infarction patients

Angioplasty Strategies in ST-Segment–Elevation Myocardial Infarction

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