scholarly journals Clinical trials with ST-segment elevation myocardial infarction: reply

2006 ◽  
Vol 27 (17) ◽  
pp. 2141-2141
Author(s):  
A. Orlandini
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals Complete revascularization reduces cardiovascular death in patients with ST-segment elevation myocardial infarction and multivessel disease: systematic review and meta-analysis of randomized clinical trials

2019 ◽  
Vol 41 (42) ◽  
pp. 4103-4110 ◽  
Author(s):  
Rita Pavasini ◽  
Simone Biscaglia ◽  
Emanuele Barbato ◽  
Matteo Tebaldi ◽  
Dariusz Dudek ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Multivessel Disease ◽  
Complete Revascularization ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Aims The aim of this work was to investigate the prognostic impact of revascularization of non-culprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease by performing a meta-analysis of available randomized clinical trials (RCTs). Methods and results Data from six RCTs comparing complete vs. culprit-only revascularization in STEMI patients with multivessel disease were analysed with random effect generic inverse variance method meta-analysis. The endpoints were expressed as hazard ratio (HR) with 95% confidence interval (CI). The primary outcome was cardiovascular death. Main secondary outcomes of interest were all-cause death, myocardial infarction (MI), and repeated coronary revascularization. Overall, 6528 patients were included (3139 complete group, 3389 culprit-only group). After a follow-up ranging between 1 and 3 years (median 2 years), cardiovascular death was significantly reduced in the group receiving complete revascularization (HR 0.62, 95% CI 0.39–0.97, I2 = 29%). The number needed to treat to prevent one cardiovascular death was 70 (95% CI 36–150). The secondary endpoints MI and revascularization were also significantly reduced (HR 0.68, 95% CI 0.55–0.84, I2 = 0% and HR 0.29, 95% CI 0.22–0.38, I2 = 36%, respectively). Needed to treats were 45 (95% CI 37–55) for MI and 8 (95% CI 5–13) for revascularization. All-cause death (HR 0.81, 95% CI 0.56–1.16, I2 = 27%) was not affected by the revascularization strategy. Conclusion In a selected study population of STEMI patients with multivessel disease, a complete revascularization strategy is associated with a reduction in cardiovascular death. This reduction is concomitant with that of MI and the need of repeated revascularization.

Treatment of ST-segment elevation acute coronary syndromes

ESC CardioMed ◽  
2018 ◽  
pp. 1255-1276
Author(s):  
Borja Ibanez ◽  
Sigrun Halvorsen
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Clinical Trials ◽  
Acute Coronary Syndromes ◽  
Real Life ◽  
Compelling Evidence ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes

Over the last 50 years, the treatment of acute ST-segment elevation myocardial infarction (STEMI) has been considerably improved. The widespread implementation of reperfusion (initially pharmacological and later mechanical) resulted in a magnificent reduction in the rates of in-hospital mortality from about 25% in the 1970s to 5% in the late 2010s. Mortality in real life, however, is higher than these figures shown in clinical trials. There is compelling evidence showing the association between duration of ischaemia and mortality. This is the basis for the timely reperfusion in STEMI. All actions should be made to reduce all components of the ischaemic time. Despite these advances, STEMI survivors are still at high risk for developing repetitive events, including reinfarctions, heart failure, and sudden death. Evolving therapies beyond timely reperfusion are contributing to further reduce the morbidity associated with STEMI.

scholarly journals Outcomes of patients in clinical trials with ST-segment elevation myocardial infarction among countries with different gross national incomes

2006 ◽  
Vol 27 (5) ◽  
pp. 527-533 ◽  
Author(s):  
Andrés Orlandini ◽  
Rafael Díaz ◽  
Daniel Wojdyla ◽  
Karen Pieper ◽  
Frans Van de Werf ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Anticoagulation in the Management of ST-Segment Elevation Myocardial Infarction

2010 ◽  
Vol 23 (4) ◽  
pp. 335-343
Author(s):  
Paul P. Dobesh ◽  
Toby C. Trujillo
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Anticoagulant Therapy ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Detailed Examination ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Reperfusion Strategy

Patients with ST-segment elevation myocardial infarction (STEMI) require immediate reperfusion therapy in order to salvage ischemic myocardial tissue and reduce mortality. Reperfusion therapy can be provided mechanically with primary percutaneous coronary intervention (PCI), or pharmacologically with fibrinolysis. Regardless of the reperfusion strategy selected, the appropriate use of anticoagulant therapy is critical to its success. There have been a number of clinical trials evaluating the different anticoagulants in patients with STEMI, as well as recent updates to the guidelines for management of patients with STEMI and on the use of PCI. When making clinical decisions on the use of anticoagulant therapy in the management of patients with STEMI, it is important to not only understand the contents of these consensus guidelines but to also have an appreciation of the details of the clinical trials that have evaluated the different anticoagulants. In this review, the reader will find an evaluation of the current guidelines concerning the use of anticoagulant therapy in patients with STEMI as well as a detailed examination of the literature with critical analysis on issues that should be considered when deciding on the appropriate implementation of anticoagulant therapy in patients with STEMI undergoing either mechanical or pharmacologic reperfusion.

Treatment of ST-segment elevation acute coronary syndromes

ESC CardioMed ◽  
2018 ◽  
pp. 1255-1276
Author(s):  
Borja Ibanez ◽  
Sigrun Halvorsen
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Clinical Trials ◽  
Acute Coronary Syndromes ◽  
Real Life ◽  
Compelling Evidence ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes

Over the last 50 years, the treatment of acute ST-segment elevation myocardial infarction (STEMI) has been considerably improved. The widespread implementation of reperfusion (initially pharmacological and later mechanical) resulted in a magnificent reduction in the rates of in-hospital mortality from about 25% in the 1970s to 5% in the late 2010s. Mortality in real life, however, is higher than these figures shown in clinical trials. There is compelling evidence showing the association between duration of ischaemia and mortality. This is the basis for the timely reperfusion in STEMI. All actions should be made to reduce all components of the ischaemic time. Despite these advances, STEMI survivors are still at high risk for developing repetitive events, including reinfarctions, heart failure, and sudden death. Evolving therapies beyond timely reperfusion are contributing to further reduce the morbidity associated with STEMI.

Early Treatment of ST-segment-elevation Myocardial Infarction Incorporating Results of the FINESSE Trial

2009 ◽  
Vol 5 (1) ◽  
pp. 85 ◽  
Author(s):  
Luc Janssens ◽  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Clinical Benefit ◽  
Bleeding Risk ◽  
Risk Groups ◽  
Coronary Intervention ◽  
Primary Angioplasty ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

A significant mortality reduction has been observed in the last few decades in the treatment of ST-segment-elevation myocardial infarction (STEMI), mainly due to pharmacological and/or mechanical reperfusion therapies. Primary angioplasty has provided further survival benefits compared with thrombolysis. Treatment delays are still common for patients with STEMI who are referred for primary percutaneous coronary intervention (PCI), and have led to clinical trials evaluating the possible clinical benefit of ‘facilitated’ PCI. Clinical trials – principally Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events (FINESSE) – were not able to demonstrate a net clinical benefit of pre-PCI pharmacological reperfusion with thrombolytics, glycoprotein IIb/IIIa inhibitors or a combination of both therapies. At the same time, the data suggest further study may be needed in certain high-risk groups to address the need to find therapies that improve reperfusion without greatly increasing bleeding risk.

Sign in / Sign up

Export Citation Format

Share Document