Early referral for intentional rescue PTCA after initiation of thrombolytic therapy in patients admitted to a community hospital because of a large acute myocardial infarction

Ophuis, Ton J.M. Oude; Vermeer, Frank; Krijne, Ruud; Jansen, Ward P J; Swart, Hans de; Ommen, Vincent van; Zwaan, Chris de; Engelen, Domien J; Dassen, W.R.M.; Wellens, Hein J.J.

doi:10.1016/s0002-8703(99)70408-4

Cited by 27 publications

(14 citation statements)

References 35 publications

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“…Gore et al [24] in 1989 and Bellinger et al [25] in 1988 already demonstrated the safety of such transportation, if it was performed by experienced personnel. These results were confirmed by recent studies [26][27][28][29].…”

Section: Possible Reasons For the Discrepancies Between Current Practsupporting

confidence: 89%

Transfer of Patients with Acute Myocardial Infarction for Primary or Acute Angioplasty from Hospitals without the Facilities to Perform Angioplasty Results from the Pooled Data of the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Registry and the Myocardial Infarction Registry (MIR)

Zahn

Schiele²,

Schneider³

et al. 2000

Herz

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In patients with acute myocardial infarction (AMI) admitted at hospitals without angioplasty facilities there are some subgroups of patients which seem to profit from a transfer to primary or acute angioplasty. However, current clinical practice at such hospitals is unknown. We analyzed the pooled data of the German acute myocardial infarction registries MITRA and the MIR. Angioplasty was not available at 221/271 hospitals (81.5%). Out of 14,487 patients with acute myocardial infarction admitted to these hospitals, 50.1% (7,259/14,487) received thrombolysis at the initial hospital and 3.6% (523/14,487) were transferred. Out of the transferred patients, 55.3% (289/523) were treated with primary angioplasty and 44.7% (234/523) received a combination of thrombolysis and angioplasty. The proportion of transferred patients increased from 1.1% in 1994 to 5.5% in 1998 (p for trend = 0.001). One hundred and four hospitals (47.1%) never transferred patients. Patients transferred for primary angioplasty (289 patients) were compared to patients treated with thrombolysis at the initial hospitals (7,259 patients). Multivariate analysis showed the following independent predictors for transfer of patients for primary angioplasty: contraindications for thrombolysis (OR = 17.9), a non-diagnostic first ECG (OR = 4.0), pre-hospital delay > 6 hours (OR = 2.5), unknown symptom onset of the acute myocardial infarction (OR = 2.0) and anterior wall acute myocardial infarction (OR = 1.6). Heart failure at admission was the only independent predictor not to transfer patients (OR = 0.40). In Germany only 47.1% of hospitals without angioplasty facilities transfer patients with acute myocardial infarction to primary or acute angioplasty. The proportion of transferred patients increased from 1.1% in 1994 to 5.5% in 1998. Contraindications for thrombolysis were the strongest predictor to transfer patients to primary angioplasty.

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Section: Possible Reasons For the Discrepancies Between Current Practsupporting

confidence: 89%

Transfer of Patients with Acute Myocardial Infarction for Primary or Acute Angioplasty from Hospitals without the Facilities to Perform Angioplasty Results from the Pooled Data of the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Registry and the Myocardial Infarction Registry (MIR)

Zahn

Schiele²,

Schneider³

et al. 2000

Herz

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“…Also, in the United States, [3][4][5][6][7][8][9][10][11] Australia, 12) Canada, 13) the United Kingdom, [14][15][16][17] France, [18][19][20] Switzerland, 21,22) Israel, 23,24) Austria, 25) Spain, 26) Portugal, [27][28][29] Italy, [30][31][32] Finland, 33) Sweden, 34) Germany, [35][36][37][38][39] Denmark, 40,41) the Netherlands [42][43][44] and in Belgium, [45][46][47] there is controversy about the preferential use of thrombolytics and/or rescue PTCA and stenting. Up to now it is not known which therapy provides the best results in the longterm with total patency or TIMI 3 patency.…”

mentioning

confidence: 99%

Changes in Mortality of Acute Myocardial Infarction as a Function of a Changing Treatment during the last Two Decades

Claessens

et al. 2000

Jpn Heart J

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SUMMARYForty years ago, after the establishment of coronary care units, a significant decrease in mortality of acute myocardial infarction was noted. Twenty years ago, the breakthrough of thrombolysis realized once again a significant decrease in mortality. In this study we compare, in a rather small community hospital, the mortality and safety of thrombolytic therapy in acute myocardial infarction with a more conventional, conservative medical therapy.We examined all cases of acute myocardial infarction between 1978 up to 1998 inclusive, concerning treatment and mortality rate after a six month period. To be included in the study, acute myocardial infarction had to fulfill particular inclusion criteria. A total of 1863 cases of acute myocardial infarction were included.The mortality rate of patients with acute myocardial infarction treated with thrombolytic agents was strikingly lower and statistically very significantly different (p < 0.001) in comparison with the mortality rate of patients treated with heparin or coumarine derivatives.The mortality rate dropped from 10.57% in the coumarine group and from 14.95% in the heparin group to 5.41% in the alteplase group, to 4.95% in the anistreplase group and 4.00% in the streptokinase subgroup.The complications directly connected to the treatment did not seem to be different between the five groups, and they were also not more frequent by using thrombolytic agents.In the last 20 years, better preventive measures (life habits, diet, medication) and trials to better control the risk factors have not influenced greatly the average amount of cholesterol in patients with an acute myocardial infarction. Also the percentage of patients with high blood pressure has hardly decreased over the last 20 years.The mortality associated with acute myocardial infarction has decreased significantly with the use of thrombolytics. In most cases, thrombolytics are administered routinely and safely. In this way, they are the first choice therapy for myocardial infarction in smaller hospitals.

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“…Nevertheless, several large series have documented the safety and feasibility of transferring patients to PCI centres after thrombolysis. 16,23,30 Ongoing randomized trials are comparing the secondary transfer of patients for immediate or early PCI after thrombolysis with initial stabilization in community emergency departments or in prehospital settings.…”

Section: Discussionmentioning

confidence: 99%

Immediate angioplasty after thrombolysis: a systematic review

Cantor

Brunet²,

Ziegler³

et al. 2005

Canadian Medical Association Journal

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Early referral for intentional rescue PTCA after initiation of thrombolytic therapy in patients admitted to a community hospital because of a large acute myocardial infarction

Cited by 27 publications

References 35 publications

Changes in Mortality of Acute Myocardial Infarction as a Function of a Changing Treatment during the last Two Decades

Immediate angioplasty after thrombolysis: a systematic review

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