Incidence and prognosis of secondary ventricular fibrillation in acute myocardial infarction. Evidence for a protective effect of thrombolytic therapy. GISSI Investigators.

Volpi, Alberto; Cavalli, A; Santoro, Eugenio; Tognoni, Gianni

doi:10.1161/01.cir.82.4.1279

Cited by 64 publications

(18 citation statements)

References 47 publications

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“…However, reperfusion therapy by thrombolytic therapy has been shown to improve survival when administered up to 12 hours after infarct onset,'4 and it has been suggested that this benefit occurs via changes in ventricular diastolic function and healing, and possibly via a decrease in susceptibility to serious arrhythmias. [4][5][6] Nearly immediate improvement in diastolic function with very delayed reperfusion has been demonstrated in animal models of infarction,29 and reduction in ventricular tachycardias by streptokinase therapy was observed in GISSI I.6 Assuming this paradigm to be correct, then any benefit from rescue angioplasty would need to result from angioplasty affecting a higher incidence of, or earlier, reperfusion than might be expected by delayed lytic-mediated reperfusion13 and not be offset by any adverse effect of the angioplasty procedure itself." Data from this study and its much smaller predecessor,19 taken together, strongly suggest that rescue angioplasty may exert a benefit for selected patients and that the responsible mechanism(s) likely involve improved diastolic function and/or systolic function under stress.…”

Section: Discussionmentioning

confidence: 99%

Randomized comparison of rescue angioplasty with conservative management of patients with early failure of thrombolysis for acute anterior myocardial infarction.

et al. 1994

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for the RESCUE Investigators Background When used in the setting of acute myocardial infarction, intravenous thrombolytic agents fail to achieve early infarct artery patency in 15% to 50% of patients. We tested the hypothesis that immediate balloon angioplasty applied to patients with failed early reperfusion would improve left ventricular function and clinical outcome at 30 days compared with conservative management alone.Methods and Results One hundred fifty-one patients with first anterior wall infarction treated with any accepted intravenous thrombolytic regimen and angiographically demonstrated to have an occluded infarct vessel within 8 hours of chest pain onset were randomized to aspirin, heparin, and coronary vasodilators (conservative therapy) or to this therapy and balloon angioplasty supplemented by further thrombolytic therapy as needed. Left ventricular function was assessed using multiple-gated equilibrium radionuclide technique to determine ejection fraction, and adverse clinical outcome was assessed evaluating death, ventricular tachycardia, and class III or IV heart failure at 30 days. Seventy-three patients were randomized to conservative therapy and 78 to angioplasty. The two groups were well balanced for patient age (59+11 years), I 1% and 7% (P=.11), and either death or severe heart failure in 6% and 17% (P=.05) of the angioplasty and conservatively managed groups, respectively. Conclusions When applied to patients with first anterior infarction, rescue angioplasty appears to be useful in the prevention of death or severe heart failure, with improvement in exercise, but not resting, ejection fraction. This strategy deserves further study and highlights the potential advantage of early mechanical restoration of infarct vessel patency when thrombolytic therapy has failed. (Circulation. 1994;90:2280-2284 Key Words * angioplasty * thrombolysis * infarction to be a marker of subsequent survival.9,10 Early coronary angioplasty may successfully open 75% to 85% of occluded arteries in this setting,1' and in part because it seems intuitive to many physicians that the infarct artery should be opened promptly, angioplasty is frequently applied in this setting despite the absence of clinical trials justifying its use.11'12 It is well recognized that 30% to 60% of infarct arteries that are closed 90 minutes after thrombolytic therapy will open within the time window when clinical benefit may still accrue.'13'4 Furthermore, rescue angioplasty may be costly and, when it fails, is associated with a high mortality"; therefore, its practice remains highly controversial.11,12Our aim was to assess the clinical benefit of rescue angioplasty in a select relatively homogeneous and high-risk (no prior myocardial infarction, chest pain of less than 8 hours, anterior location) patient population in a randomized study of 151 patients from 20 centers. Methods PatientsBetween January 1990 and March 1993, all patients meeting enrollment criteria at 20 sites were sought for randomization. To assess possible bias in pati...

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Section: Discussionmentioning

confidence: 99%

Randomized comparison of rescue angioplasty with conservative management of patients with early failure of thrombolysis for acute anterior myocardial infarction.

et al. 1994

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“…The episodes of VF observed in the CL may be related to injury secondary to the faster reperfusion obtained with PCI. The link between VF development and the rate of restoration of blood flow after coronary occlusion was previously described in several studies based on experimental models (14)(15)(16)(17)(18).…”

Section: Vfmentioning

confidence: 99%

Timing, setting and incidence of cardiovascular complications in patients with acute myocardial infarction submitted to primary percutaneous coronary intervention

Giglioli¹,

Margheri²,

Valente³

et al. 2006

Canadian Journal of Cardiology

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“…This percentage may vary according to the agent and dosing regimen used [3][4][5]. Patients with failed thrombolytic therapy are at higher risk due to left ventricular dysfunction, life-threatening arrhythmias and death [6][7][8]. Although it may seem obvious that rescue (salvage) percutaneous transluminal coronary angioplasty (PTCA) of the IRA would benefit the prognosis of these patients, its clinical value still remains controversial [9][10][11][12].…”

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confidence: 99%

Rescue Coronary Angiography after Failed Thrombolysis: A Real-Life Experience

Gruberg

Segni²,

Agranat³

et al. 1998

Cardiology

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Failed thrombolysis in acute myocardial infarction (AMI) patients is associated with a high risk of morbidity and mortality. Rescue or salvage percutaneous transluminal coronary angioplasty (PTCA) in this group of patients is still controversial. We report our experience with early emergency angiography and rescue PTCA in 27 patients who were hemodynamically unstable or had a large area of myocardium at risk after failed thrombolysis. Rescue PTCA was successful in 95% of attempted PTCA. Three patients were referred to emergency CABG. Early ‘rescue angiography’ with or without rescue PTCA after failed thrombolysis in a selected patient population, is an important tool for early risk stratification and decision-making during the hyperacute phase of AMI, while it may also serve in restoring coronary artery patency of the infarct-related artery with a high success rate.

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Incidence and prognosis of secondary ventricular fibrillation in acute myocardial infarction. Evidence for a protective effect of thrombolytic therapy. GISSI Investigators.

Abstract: (Circulation 1990;82:1279-1288

Cited by 64 publications

References 47 publications

Randomized comparison of rescue angioplasty with conservative management of patients with early failure of thrombolysis for acute anterior myocardial infarction.

Randomized comparison of rescue angioplasty with conservative management of patients with early failure of thrombolysis for acute anterior myocardial infarction.

Timing, setting and incidence of cardiovascular complications in patients with acute myocardial infarction submitted to primary percutaneous coronary intervention

Rescue Coronary Angiography after Failed Thrombolysis: A Real-Life Experience

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