Hospital mortality in acute myocardial infarction in the era of reperfusion therapy (the myocardial infarction triage and intervention project)

Maynard, Charles; Weaver, W. Douglas; Litwin, Paul E.; Martin, Jennifer; Kudenchuk, Peter J.; Dewhurst, Timothy A.; Eisenberg, Mickey S.; Hallstrom, Alfred P.; Chambers, Joseph

doi:10.1016/0002-9149(93)91099-4

Cited by 67 publications

(25 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The mechanism associated with this interrelationship is still unclear, but it is likely to be related to the small coronary and myocardial reserve seen in older individuals, since the incidence of diabetes, arterial hypertension or congestive heart failure is higher in these patients 13,19 . In the present study, increased mortality in more advanced age groups was also found.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Complicação infecciosa indica mau prognóstico no infarto agudo do miocárdio

Júnior

Caramelli

2006

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

“…The relationship between feminine gender and higher in-hospital mortality is also known, and some authors suggest that this is an independent variable related do mortality 13,[19][20][21][22][23] . In our study, the number of women in the infected group was higher, indicating that they are more prone to develop infectious complication.…”

Section: Discussionmentioning

confidence: 99%

Complicação infecciosa indica mau prognóstico no infarto agudo do miocárdio

Júnior

Caramelli

2006

Arq. Bras. Cardiol.

View full text Add to dashboard Cite

“…One available study demonstrated that the presence of hyperlipidemia negatively correlated with mortality of reperfusion therapy. 22 Thus, hyperlipidemia might have favorably affected the early and intermediate follow-up LV function in group N, although the mechanism for favorable outcome in dyslipidemic patients is uncertain. Another limitation of our study is a study design.…”

Section: Study Limitationmentioning

confidence: 99%

Effects of Intravenous Administration of Tissue Plasminogen Activator Before Thrombectomy in Patients With Acute Myocardial Infarction

Yamamoto

Kamihata

Sutani

et al. 2006

Circ J

View full text Add to dashboard Cite

ercutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI) carries a risk of distal embolization of atheromatous and thrombic debris. These adverse effects of PCI potentially result in so-called 'no-reflow phenomenon', which is characterized by impaired myocardial perfusion, despite reopening of the epicardial coronary arteries. 1,2 Embolization of plaque and thrombic debris induced by PCI can lead to the obstruction of distal coronary arteries, limiting the efficacy, and the extent of myocardial reperfusion. 3 The impaired coronary microcirculation after PCI causes persistent abnormality in myocardial metabolism and increased cardiomyocyte death, which might limit myocardial salvage gained by PCI. [3][4][5] A number of techniques to protect against distal embolization during PCI have developed in recent years. Of these, several studies have emphasized the efficacy of thrombectomy before PCI in reducing distal embolization and improving coronary microvascular perfusion. 6,7 However, the efficacy of thrombectomy is limited by the fact that complete aspiration of thrombus before PIC is not possible and residual thrombus are liberated during PCI. 8 Therefore, we designed a prospective and randomized trial to test the hypothesis whether thrombolysis by intra- Circulation Journal Vol.70, March 2006venous administration with mutant tissue plasminogen activator (Mt-PA) improves the outcome of thrombectomy and PCI in patents with AMI. The rationale for using Mt-PA before thrombectomy and PCI in patients with AMI is 2-fold. First, this facilitated PCI technique might enhance the efficacy of PIC by earlier reopening of infarction-related artery (IRA). Second, thrombolysis by Mt-PA before thrombectomy might allow more complete aspiration of thrombic debris by thrombectomy devices, thereby improving the efficacy of thrombectomy to protect coronary microcirculation. The results of our trial suggest that although the use of Mt-PA before thrombectomy improves coronary microcirculation immediately after PCI, it is not superior in improving left ventricular (LV) function over thrombectomy alone. Methods SubjectsConsecutive 44 patients who were admitted in our coronary care unit for the first onset of ST-segment elevation AMI without contraindication for Mt-PA were enrolled in the study. These patients received the initial therapy by oral administration with 100 mg of aspirin and 100 mg of ticlopidine and intravenous administration with 60 units/kg of haparin and, when necessary, they received intravenous isosorbide dinitrite and/or propranolol. They were, then, randomly assigned to either thrombectomy with Mt-PA pretreatment (group T; n=23) or thrombectomy alone (group N; n=21) using an envelope method. Group T patients received a bolus half-dose of monteplase (13,750 IU/kg) intravenously. The protocol of the study was approved by Background Myocardial salvage after acute myocardial infarction (AMI) largely depends on the removal of infarct-related thrombus. Although both thrombolysis and thrombe...

show abstract

“…The Myocardial Infarction Triage and Intervention (MITI) Project in Seattle, WA, reported a 28% rate of reperfusion therapy within six hours of symptom onset. 24 The MITI investigators also reported a 10% in-hospital death rate. There was a 6.7% death rate in our primary population.…”

Section: Limitations and Future Questionsmentioning

confidence: 98%

Impact of Community Intervention to Reduce Patient Delay Time on Use of Reperfusion Therapy for Acute Myocardial Infarction Rapid Early Action for Coronary Treatment (REACT) Trial

Hedges

Feldman

Bittner

et al. 2000

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

Abstract. Background: Reperfusion therapy for acute myocardial infarction (AMI) is a time-dependent intervention that can reduce infarct-related morbidity and mortality. Out-of-hospital patient delay from symptom onset until emergency department (ED) presentation may reduce the expected benefit of reperfusion therapy. Objective: To determine the impact of a community educational intervention to reduce patient delay time on the use of reperfusion therapy for AMI. Methods: This was a randomized, controlled community-based trial to enhance patient recognition of AMI symptoms and encourage early ED presentation with resultant increased reperfusion therapy rates for AMI. The study took place in 44 hospitals in 20 pair-matched communities in five U.S. geographic regions. Eligible study subjects were noninstitutionalized patients without chest injury (aged Ն30 years) who were admitted to participating hospitals and who received a hospital discharge diagnosis of AMI (ICD 410); n = 4,885. For outcome assessment, patients were excluded if they were without survival data (n = 402), enrolled in thrombolytic trials (n = 61), receiving reperfusion therapy >12 hours after ED arrival (n = 628), or missing symptom onset or reperfusion times (n = 781). The applied intervention was an educational program targeting community organizations and the general public, high-risk patients, and health professionals in target communities. The primary outcome was a change in the proportion of AMI patients receiving early reperfusion therapy (i.e., within one hour of ED arrival or within six hours of symptom onset). Trends in reperfusion therapy rates were determined after adjustment for patient demographics, presenting blood pressure, cardiac history, and insurance status. Four-month baseline was compared with the 18-month intervention period. Results: Of 3,013 selected AMI patients, 40% received reperfusion therapy. Eighteen percent received therapy within one hour of ED arrival (46% of treated patients), and 32% within six hours of symptom onset (80% of treated patients). No significant difference in the trends in reperfusion therapy rates was attributable to the intervention, although increases in early reperfusion therapy rates were noted during the first six months of the intervention. A significant association of early reperfusion therapy use with ambulance use was identified. Conclusions: Community-wide educational efforts to enhance patient response to AMI symptoms may not translate into sustained changes in reperfusion practices. However, an increased odds for early reperfusion therapy use during the initiation of the intervention and the association of early therapy with ambulance use suggest that reperfusion therapy rates can be enhanced.

show abstract

Hospital mortality in acute myocardial infarction in the era of reperfusion therapy (the myocardial infarction triage and intervention project)

Cited by 67 publications

References 14 publications

Complicação infecciosa indica mau prognóstico no infarto agudo do miocárdio

Complicação infecciosa indica mau prognóstico no infarto agudo do miocárdio

Effects of Intravenous Administration of Tissue Plasminogen Activator Before Thrombectomy in Patients With Acute Myocardial Infarction

Impact of Community Intervention to Reduce Patient Delay Time on Use of Reperfusion Therapy for Acute Myocardial Infarction Rapid Early Action for Coronary Treatment (REACT) Trial

Contact Info

Product

Resources

About