RANDOMIZED COMPARISON OF PREHOSPITAL INITIATED FACILITATED PCI VERSUS PRIMARY PCI IN ACUTE MYOCARDIAL INFARCTION WITH < 3 H AFTER SYMPTOM ONSET

Acute myocardial infarction with ST-segment elevation (STEMI) remains a major global public health issue. Despite advances in therapy, patients remain at risk for death, repeat myocardial infarction (MI) shock and heart failure (HF). Novel markers that predict those at risk are needed. We studied 903 STEMI patients in The Assessment of Pexelizumab in Acute Myocardial Infarction trial (which enrolled STEMI patients presenting < 6 hrs of symptom onset who were to undergo primary PCI) in a case-control design (cases selected based on the trial’s primary composite outcome - death, shock or HF - and matched on age, gender and infarct location to controls). NT-proBNP (pg/ml) was measured at randomization and 24 hrs. Outcomes (individually and the composite) of death, shock, and HF at 90 days were examined by quartiles of NT-proBNP. A CART model was used to categorize adjusted risk. NT-proBNP was higher in patients who had events. Patients with higher NT-proBNP levels at baseline (median symptom onset to randomization 2.7 hrs) and 24 hrs had more events (composite p<0.001; death p<0.0001; HF p<0.0001; shock p=0.05) - See figure . Using the CART model (adjusted for age, gender and infarct location), baseline Killip class and NT-proBNP could further subcategorize patients into 90 day mortality categories 4%, 10%, 30%, and 53%. In fact, only 4 patients (1%) with a 24 hour NT-proBNP <999 pg/ml had any event in the next 90 days. Although the overall prognosis in STEMI patients undergoing primary PCI is good, NT-proBNP performed early and at 24 hrs provides important prognostic information for predicting negative outcomes i.e. shock, heart failure and death. Figure. Kaplan-Meier curve for the primary composite outcome stratified by baseline NT-proBNP (a), or 24 hour NT-proBNP (b).

Download Full-text

Myocardial salvage and infarct size in acute myocardial infarction assessed by magnetic resonance imaging - Influences by prehospital initiated facilitated PCI versus primary PCI in early infarct presenters

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/1532-429x-12-s1-p206 ◽

2010 ◽

Vol 12 (S1) ◽

Author(s):

Holger Thiele ◽

Ingo Eitel ◽

Claudia Meinberg ◽

Matthias Gutberlet ◽

Gerhard Schuler

Keyword(s):

Magnetic Resonance Imaging ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Magnetic Resonance ◽

Infarct Size ◽

Myocardial Salvage ◽

Primary Pci ◽

Resonance Imaging ◽

Facilitated Pci

Download Full-text

e0637 A compared study of facilitated PCI and primary PCI on acute myocardial infarction via transradial artery approach

Heart ◽

10.1136/hrt.2010.208967.637 ◽

2010 ◽

Vol 96 (Suppl 3) ◽

pp. A197-A197

Author(s):

F. Xianghua ◽

L. Jun ◽

G. Xinshun ◽

W. Yongyun ◽

F. Weize ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Primary Pci ◽

Facilitated Pci

Download Full-text

Treatment delay in STEMI is associated with heart failure and mortality. National data from the Norwegian myocardial infarction register

European Heart Journal ◽

10.1093/ehjci/ehaa946.1350 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K.K Halle ◽

R.E.S Govatsmark ◽

K.H Bonaa

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Acute Myocardial Infarction ◽

Time Delay ◽

Symptom Onset ◽

Missing Values ◽

Outcome Variable ◽

P Value ◽

Primary Pci ◽

Increased Risk

Abstract Background European guidelines in ST-segment elevation acute myocardial infarction (STEMI) recommends a primary PCI (P-PCI) strategy if wire crossing of the occluded artery can be performed within 120 min of ECG diagnosis. A large proportion of the Norwegian population lives in remote geographical areas where P-PCI may not be performed expeditiously. Time delay from first medical contact to primary PCI is expected to be related to outcomes like heart failure and mortality. Norwegian hospitals are by law required to register clinical data for all patients treated for acute myocardial infarction in the Norwegian Myocardial Infarction. The register includes >90% of eligible patients. Purpose The aim of the study was to investigate the association of time from first medical contact (FMC) to P-PCI with heart failure (EF <50%) and mortality. Methods The study includes all patients registered during 2015–2018 in the Norwegian Myocardial Infarction Registry with STEMI who were <85 years of age and had <12 hours from symptom onset to FMC. For patients with missing values, FMC was calculated as time of prehospital ECG minus 10 minutes. The primary outcome variable was heart failure (defined as ejection fraction <50% during hospitalization) or all-cause mortality within 1 year after hospitalization. We calculated ORs (95% CI) adjusted for age, gender, and history of myocardial infarction, hypertension, diabetes, and heart failure. Results During 2015–2018 a total of 6398 STEMI patients <85 years of age were registered in the Norwegian Myocardial Infarction Registry with less than 12 hours from symptom onset to FMC. Time delay from FMC to P-PCI were <90 minutes, 90–119 minutes, and >120 minutes in 40%, 25%, and 35% of the patients, respectively. Compared to patients with P-PCI within 90 minutes after FMC, the multivariable adjusted OR (95% CI; p-value) for heart failure or 1 year mortality was 1.05 (1.02–1.08; p<0.01) for patients with P-PCI within 90–119 minutes after FMC, and 1.05 (1.02–1.08; p<0.001) for patients with P-PCI >120 minutes after FMC. The corresponding ORs for 1 year mortality were 1.01 (0.99–1.02) and 1.03 (1.02–1.04), respectively, and the corresponding ORs for EF<50% were 1.07 (1.04–1.11) and 1.07 (1.04–1.11). Conclusion In Norway, only 40% of STEMI patients undergo P-PCI within 90 minutes after FMC, and 35% of patients undergoes P-PCI >120 minutes after FMC. Time delays of more than 90 minutes after FMC are associated with increased risk of heart failure and mortality. A fibrinolysis strategy may be preferred over P-PCI for a substantial proportion of STEMI patients. Funding Acknowledgement Type of funding source: None

Download Full-text

Thrombolytic Therapy in the Current ERA: Myocardial Infarction and Beyond

Current Pharmaceutical Design ◽

10.2174/1381612824666171227211623 ◽

2018 ◽

Vol 24 (4) ◽

pp. 414-426 ◽

Cited By ~ 3

Author(s):

Patrick Proctor ◽

Massoud A. Leesar ◽

Arka Chatterjee

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Coronary Intervention ◽

Evidence Base ◽

Primary Pci ◽

Percutaneous Coronary

Thrombolytic therapy kick-started the era of modern cardiology but in the last few decades it has been largely supplanted by primary percutaneous coronary intervention (PCI) as the go-to treatment for acute myocardial infarction. However, these agents remain important for vast populations without access to primary PCI and acute ischemic stroke. More innovative uses have recently come up for the treatment of a variety of conditions. This article summarizes the history, evidence base and current use of thrombolytics in cardiovascular disease.

Download Full-text

Primary PCI for Acute Myocardial Infarction in a Patient with Idiopathic Thrombocytopenic Purpura

Herz ◽

10.1007/s00059-010-3262-1 ◽

2010 ◽

Vol 35 (1) ◽

pp. 43-49 ◽

Cited By ~ 13

Author(s):

Aleksandar N. Neskovic ◽

Ivan Stankovic ◽

Predrag Milicevic ◽

Aleksandar Aleksic ◽

Alja Vlahovic-Stipac ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Idiopathic Thrombocytopenic Purpura ◽

Primary Pci ◽

Thrombocytopenic Purpura

Download Full-text

Actual Role of Platelet Glycoprotein IIb/IIIa Receptor Inhibitors as Adjunctive Pharmacological Therapy to Primary Angioplasty in Acute Myocardial Infarction: In the Light of Recent Randomized Trials and Observational Studies with Bivalirudin

The Open Cardiovascular Medicine Journal ◽

10.2174/1874192401004010135 ◽

2010 ◽

Vol 4 (1) ◽

pp. 135-145 ◽

Cited By ~ 9

Author(s):

Osmar Antonio Centurión

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Unfractionated Heparin ◽

Observational Studies ◽

Randomized Trials ◽

Pharmacological Therapy ◽

Bleeding Complications ◽

Primary Pci ◽

Therapeutic Benefits ◽

Ischemic Complications

Strategies for preventing ischemic complications during percutaneous coronary interventions (PCI) in the setting of acute myocardial infarction (AMI) have focused on the platelet surface-membrane glycoprotein (GP) IIb/IIIa receptor. The platelet GP IIb/IIIa receptor inhibitors, by blocking the final common pathway of platelet aggregation, have become a breakthrough in the management of acute coronary syndromes. Current adjuvant pharmacological therapy of AMI with aspirin, clopidogrel, unfractionated heparin (UH), and platelet GP IIb/IIIa inhibitors provides useful therapeutic benefits. Although the use of more potent antithrombin and antiplatelet agents during PCI in AMI has reduced the rate of ischemic complications, in parallel, the rate of bleeding has increased. Several studies have reported an association between bleeding after PCI and an increase in morbidity and mortality. Therefore, investigational studies have focused in pharmacological agents that would reduce bleeding complications without compromising the rate of major adverse cardiovascular events. Based on the results of several randomized trials, abciximab with UH, aspirin and clopidogrel have become a standard adjunctive therapy with primary PCI for AMI. However, some of the trials were done before the use of stents and the widespread use of thienopyridines. In addition, GP IIb/IIIa inhibitors use have been associated with thrombocytopenia, high rates of bleeding, and the need for transfusions, which increase costs, length of hospital stay, and mortality. On the other hand, in the stent era, bivalirudin, a semi-synthetic direct thrombin inhibitor, has recently been shown to provide similar efficacy with less bleeding compared with unfractionated heparin plus platelet GP IIb/IIIa inhibitors in AMI patients treated with primary PCI. The impressive results of this recent randomized trial and other observational studies make a strong argument for the use of bivalirudin rather than heparin plus GP IIb/IIIa inhibitors for the great majority of patients with AMI treated with primary PCI. However, some controversial results and limitations in the studies with bivalirudin exert some doubts in the future widespread use of this drug.

Download Full-text

Abstract 2832: Which Cardiac Marker is Most Useful to Predict Final Infarct Size and Cardiac Function Following Primary Percutaneous Coronary Intervention For Acute Myocardial Infarction?

Circulation ◽

10.1161/circ.116.suppl_16.ii_630-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Stanley Chia ◽

O. Christopher Raffel ◽

Faisal Merchant ◽

Frans J Wackers ◽

Fred Senatore ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Infarct Size ◽

Troponin I ◽

Troponin T ◽

Coronary Intervention ◽

Left Ventricular ◽

Cardiac Biomarkers ◽

Primary Pci ◽

Percutaneous Coronary

Background: Assessment of cardiac biomarker release has been traditionally used to estimate the size of myocardial damage after acute myocardial infarction (AMI). However, the significance of cardiac biomarkers in the setting of primary percutaneous coronary intervention (PCI) has not been systematically studied in a large patient cohort. We evaluated the usefulness of serial and single time-point measures of various cardiac biomarkers (creatine kinase (CK), CK-MB, troponin T and I) in predicting infarct size and left ventricular ejection fraction (LVEF) after primary PCI. Methods: EVOLVE (Evaluation of MCC-135 for Left Ventricular Salvage in AMI) was a randomized double-blind, placebo-controlled trial comparing the efficacy of intracellular calcium modulator as an adjunct to primary PCI in patients with first large AMI. Levels of cardiac biomarkers (CK, CK-MB mass, troponin T and I) were determined in 375 patients at baseline before PCI and 2, 4, 12, 24, 48 and 72 hours thereafter. Single photon emission computed tomography imaging was performed to measure infarct size and LVEF on day 5. Results: Area under curve and peak concentrations of all cardiac markers: CK, CK-MB mass, troponin T and troponin I were significantly correlated with myocardial infarct size and LVEF determined on day 5 (Spearman correlation, all P< 0.001; Table ). Troponin I, however provided the best predictor and a single measure at 72 hr was a strong indicator of both infarct size and LVEF. Using receiver operator characteristics curve, troponin I cutoff value of >55 pg/mL at 72 hr has 90% sensitivity and 70% specificity for detection of large infarct size≥10% ( c =0.88; P< 0.001). Conclusions: Plasma levels of CK, CK-MB, troponin T and troponin I remain useful predictors of infarct size and cardiac function in the era of primary PCI for AMI. A single measurement of circulating troponin I at 72 hours can provide an effective and convenient indicator of infarct size and LVEF in clinical practice. Correlation of cardiac biomarkers with Day 5 SPECT determined infarct size and LVEF

Download Full-text

Treatment delay and reperfusion management of acute ST-segment elevation myocardial infarction: analysis of the China STEMI Care Project Phase 1

QJM ◽

10.1093/qjmed/hcaa186 ◽

2020 ◽

Author(s):

Y Zhang ◽

Y Tian ◽

P Dong ◽

Y Xu ◽

B Yu ◽

...

Keyword(s):

Myocardial Infarction ◽

Symptom Onset ◽

Phase 1 ◽

Coronary Intervention ◽

Treatment Delay ◽

Primary Pci ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Care Project

Summary Background The China ST-segment elevation myocardial infarction (STEMI) Care Project (CSCAP) was launched in 2011 to address the problems of insufficient reperfusion and long treatment delay in STEMI care in China. Aim To describe the baseline status of STEMI emergency care in Tertiary PCI Hospitals using Phase 1 (CSCAP-1) data. Design CSCAP-1 is a prospective multi-center STEMI registry. Methods and results A total of 4191 patients with symptom onset within 12 or 12–36 h requiring primary percutaneous coronary intervention (PCI), were enrolled from 53 tertiary PCI hospitals in 14 provinces, municipalities, and autonomous regions of China in CSCAP-1. Among them, 49.0% were self-transported to the hospital, 26.5% were transferred to the hospital by calling the emergency medical services directly, and 24.5% were transferred from other hospitals. In patients with symptom onset within 12 h, 83.2% received primary PCI, 5.9% received thrombolysis and 10.9% received conservative medications. The median door-to-balloon time was 115 (85–170) min and the median door-to-needle time for in-hospital thrombolysis was 80 (50–135) min. The overall in-hospital all-cause mortality was 2.4%, while it was 5.3% in the non-reperfusion group and 2.1% in the reperfusion group (P < 0.001). Conclusion Although a long treatment delay and a high proportion of patients transporting themselves to the hospital were observed, trends were positive with greater adoption of primary PCI and lower in-hospital mortality in tertiary hospitals in China. Our results provided important information for further integrated STEMI network construction in China.

Download Full-text