Thrombolysis in acute myocardial infarction complicated by cardiogenic shock

Levine, Glenn N.; Hochman, Judith S.

doi:10.1007/bf01063156

Cited by 13 publications

(3 citation statements)

References 41 publications

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“…In these patients, primary PCI may be a better option in terms of survival than thrombolysis. [27][28][29] Finally, in the present study, treatment was initiated in a prehospital setting, which may not be feasible in all environments. Whether these results apply to in-hospital thrombolysis for patients treated early during the course of their symptoms is uncertain.…”

Section: Steg Et Al Prehospital Rtpa Vs Primary Pcimentioning

confidence: 99%

Impact of Time to Treatment on Mortality After Prehospital Fibrinolysis or Primary Angioplasty

et al. 2003

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MD; for the Comparison of Angioplasty and Prehospital Thrombolysis In acute Myocardial infarction (CAPTIM) Investigators*Background-CAPTIM was a randomized trial comparing prehospital thrombolysis with transfer to an interventional facility (and, if needed, percutaneous intervention) with primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI). Because the benefit of thrombolysis is maximal during the first 2 hours after symptom onset, and because prehospital thrombolysis can be implemented earlier than PCI, this analysis studied the relationship between the effect of assigned treatment and the time elapsed from symptom onset. Methods and Results-Randomization within 2 hours (nϭ460) or Ն2 hours (nϭ374) after symptom onset had no impact on the effect of treatment on the 30-day combined primary end point of death, nonfatal reinfarction, and disabling stroke. However, patients randomized Ͻ2 hours after symptom onset had a strong trend toward lower 30-day mortality with prehospital thrombolysis compared with those randomized to primary PCI (2.2% versus 5.7%, Pϭ0.058), whereas mortality was similar in patients randomized Ն2 hours (5.9% versus 3.7%, Pϭ0.47). There was a significant interaction between treatment effect and delay with respect to 30-day mortality (hazard ratio 4.19, 95% CI 1.033 to 17.004, Pϭ0.045). Among patients randomized in the first 2 hours, cardiogenic shock was less frequent with lytic therapy than with primary PCI (1.3% versus 5.3%, Pϭ0.032), whereas rates were similar in patients randomized later. Conclusions-Time from symptom onset should be considered when one selects reperfusion therapy in STEMI.Prehospital thrombolysis may be preferable to primary PCI for patients treated within the first 2 hours after symptom onset.

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Section: Steg Et Al Prehospital Rtpa Vs Primary Pcimentioning

confidence: 99%

Impact of Time to Treatment on Mortality After Prehospital Fibrinolysis or Primary Angioplasty

et al. 2003

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“…15,21 We hypothesize that the lower reperfusion rate may be due to the reduced coronary reperfusion in CS; however, our results exceed historical fibrinolysis in CS reperfusion rates, which have been reported as low as 42% and may be related to more timely delivery of fibrinolysis, recognition of the need for adequate perfusion, and improved systems of STEMI care delivery. 11,22 We acknowledge that angiographic data such as pre-PCI Thrombolysis in Myocardial Infarction 3 flow was not recorded in this data set, but studies have reported that ST-segment-elevation resolution is a better global metric of epicardial and microvascular reperfusion that correlated well with clinical outcomes. 17,23 A novel finding of this analysis is that univariable point estimates for the primary composite outcome of in-hospital mortality or renal failure requiring dialysis, cardiac arrest, or MCS were lower among patients with CS treated with a pharmacoinvasive strategy.…”

Section: Discussionmentioning

confidence: 99%

Reperfusion in Patients With ST-Segment–Elevation Myocardial Infarction With Cardiogenic Shock and Prolonged Interhospital Transport Times

van Diepen,

Zheng,

Senaratne

et al. 2024

Circ: Cardiovascular Interventions

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BACKGROUND: In patients with ST-segment–elevation myocardial infarction complicated by cardiogenic shock, primary percutaneous coronary intervention (pPCI) is the preferred revascularization option. Little is known about the efficacy and safety of a pharmacoinvasive approach for patients with cardiogenic shock presenting to a non-PCI hospital with prolonged interhospital transport times. METHODS: In a retrospective analysis of geographically extensive ST-segment–elevation myocardial infarction network (2006–2021), 426 patients with cardiogenic shock and ST-segment–elevation myocardial infarction presented to a non–PCI-capable hospital and underwent reperfusion therapy (53.8% pharmacoinvasive and 46.2% pPCI). The primary clinical outcome was a composite of in-hospital mortality, renal failure requiring dialysis, cardiac arrest, or mechanical circulatory support, and the primary safety outcome was major bleeding defined as an intracranial hemorrhage or bleeding that required transfusion was compared in an inverse probability weighted model. The electrocardiographic reperfusion outcome of interest was the worst residual ST-segment–elevation. RESULTS: Patients with pharmacoinvasive treatment had longer median interhospital transport (3 hours versus 1 hour) and shorter median symptom-onset-to-reperfusion (125 minute-to-needle versus 419 minute-to-balloon) times. ST-segment resolution ≥50% on the postfibrinolysis ECG was 56.6%. Postcatheterization, worst lead residual ST-segment–elevation <1 mm (57.3% versus 46.3%; P =0.01) was higher in the pharmacoinvasive compared with the pPCI cohort, but no differences were observed in the worst lead ST-segment–elevation resolution ≥50% (77.4% versus 81.8%; P =0.57). The primary clinical end point was lower in the pharmacoinvasive cohort (35.2% versus 57.0%; inverse probability weighted odds ratio, 0.44 [95% CI, 0.26–0.72]; P <0.01) compared with patients who received pPCI. An interaction between interhospital transfer time and reperfusion strategy with all-cause mortality was observed, favoring a pharmacoinvasive approach with transfer times >60 minutes. The incidence of the primary safety outcome was 10.1% in the pharmacoinvasive arm versus 18.7% in pPCI (adjusted odds ratio, 0.41 [95% CI, 0.14–1.09]; P =0.08). CONCLUSIONS: In patients with ST-segment–elevation myocardial infarction presenting with cardiogenic shock and prolonged interhospital transport times, a pharmacoinvasive approach was associated with improved electrocardiographic reperfusion and a lower rate of death, dialysis, or mechanical circulatory support without an increase in major bleeding.

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“…Diese scheint jedoch eine verminderte Wirksamkeit bei Patienten im kardiogenen Schock zu haben [19].…”

Section: Invasive Diagnostik Und Revaskularisationunclassified

Behandlung des kardiogenen Schocks im Rahmen eines akuten Myokardinfarkts

Blazek

Fengler

Stiermaier

et al. 2014

Herz

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While the mortality rate of acute myocardial infarction has decreased drastically in the last decades, the outcome of patients with cardiogenic shock complicating acute myocardial infarction is still devastating. The effectiveness of supportive medicinal therapy of cardiogenic shock is often limited by undesired side effects (e.g. arrhythmia and increased myocardial oxygen consumption) or inadequate hemodynamic support. Mechanical circulatory support in cardiogenic shock failed to show beneficial effects on short-term and long-term survival; however, there are hints for a survival benefit in therapy refractory cardiogenic shock. Therefore, future trials need to evaluate further medicinal treatment options and also the best type of mechanical support as well as the optimal time of initiation to improve the success of therapeutic management.

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Thrombolysis in acute myocardial infarction complicated by cardiogenic shock

Cited by 13 publications

References 41 publications

Impact of Time to Treatment on Mortality After Prehospital Fibrinolysis or Primary Angioplasty

Impact of Time to Treatment on Mortality After Prehospital Fibrinolysis or Primary Angioplasty

Reperfusion in Patients With ST-Segment–Elevation Myocardial Infarction With Cardiogenic Shock and Prolonged Interhospital Transport Times

Behandlung des kardiogenen Schocks im Rahmen eines akuten Myokardinfarkts

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