Prehospital thrombolysis for STEMI where PPCI delays are unavoidable

2020 ◽  
Vol 12 (9) ◽  
pp. 361-366
Author(s):  
David Lashwood
Keyword(s):  
Myocardial Infarction ◽  
Gold Standard ◽  
Hospital Setting ◽  
Coronary Intervention ◽  
Time Frame ◽  
Clinical Findings ◽  
Hospital Funding ◽  
Prehospital Thrombolysis ◽  
The Uk ◽  
Patients Experience

Background: Primary percutaneous coronary intervention (PPCI) is the gold standard for treating patients experiencing ST-elevation acute myocardial infarction (STEMI). More than 30 000 patients experience cardiac arrest out of a hospital setting in the UK every year and may be some distance from a PPCI facility. Aims: To analyse and consider if a better outcome could be achieved for patients if PPCI was an adjunct to thrombolytic therapy, where delays of ≥60 minutes are inevitable or unavoidable. Methods: The current review examined a range of articles, research materials and databases. Results: Some studies suggested the use of prehospital thrombolysis while others compared the effectiveness of drug-eluting stents. While the ‘gold standard’ for the treatment of patients experiencing a myocardial infarction is still PPCI, several factors can delay patients from receiving this treatment at an appropriate facility within the recommended time frame. Conclusion: Patients may not be able to access PPCI within 60, 90 or 120 minutes for reasons including increasing urbanisation, population growth and NHS hospital funding cuts. If the PPCI unit is some distance away, ambulance crews could start thrombolysis treatment and transmit clinical findings to a specialist cardiologist in the PPCI facility, or stop at a local hospital that could provide thrombolysis.

scholarly journals Early thrombolysis: time to change? A discussion paper

2015 ◽  
Vol 3 (4) ◽  
Author(s):  
Malcolm Woollard
Keyword(s):  
Symptom Onset ◽  
Rural Areas ◽  
Treatment Time ◽  
Hospital Setting ◽  
Coronary Intervention ◽  
Time Frame ◽  
Urban Setting ◽  
Discussion Paper ◽  
Thrombolytic Agents ◽  
Published Evidence

UK Department of Health standards for the management of out-of-hospital thrombolysis require a call to thrombolysis time of 60 minutes or less, but suggest that administration of such treatment in the pre-hospital setting should be limited to cases where the journey time to hospital exceeds 30 minutes. This policy was set despite more than 50% of patients in an urban setting having a call to hospital door time of more than 30 minutes, rising to more than 80% in rural areas, and that all published evidence suggests symptom to treatment time is the critical interval. Maximum benefits are derived from thrombolytic agents if they are delivered early. Administration within 30 minutes of symptom onset can result in total abortion of a myocardial infarction, and each minutes delay to treatment is equivalent to an average of 11 days of life lost. Pre-hospital lysis within two hours of symptom onset results in a significantly lower incidence of cardiogenic shock than percutaneous coronary intervention within the same time frame, suggesting greater salvage of cardiac muscle. The available evidence suggests that pre-hospital thrombolysis is at least as safe as in-hospital administration, regardless of the qualifications and experience of the practitioner providing the treatment. All patients benefit from the shortest possible interval from symptom onset to recanalization: minutes do count. UK standards should be amended to reflect this evidence and to mandate the administration of thrombolytic agents to all eligible patients as soon as they are identified in the pre-hospital setting, regardless of distance to hospital.

Abstract 1999: Percutaneous Coronary Intervention with Off-site Cardiac Surgery Backup for Acute Myocardial Infarction as a Strategy to Reduce Door-to-Balloon Time.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Victor A Umans ◽  
Hans O Peels ◽  
Hans de Swart ◽  
Raymond Hautvast
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Cardiac Surgery ◽  
Community Hospital ◽  
Hospital Setting ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
Tertiary Center ◽  
Door To Balloon

We sought to determine whether primary percutaneous coronary intervention (PCI) for patients admitted with an acute ST-segment elevation myocardial infarction (STEMI) can be performed more rapidly and with comparable outcomes in a community hospital vs. a tertiary center with cardiac surgery. We started the first PCI with off-site surgery program in the Netherlands in 2002 and report the results of 639 consecutive pts. In the safety phase, 199 patients presenting with STEMI were randomly assigned to treatment at our off-site center vs a more distant cardiac surgery center. In the confirmation phase, 440 consecutive patients were treated in the off-site hospital. Safety and efficacy endpoints were the rate of angiographically successful PCI procedure (diameter stenosis <50% and TIMI 3 flow) in the absence of major adverse cardiac and cerebrovascular events (MACCE) at 30 days. The randomization phase showed a significant decrease of 37 minutes in door-to-balloon time (p<0.001) with comparable procedural and clinical success (91% TIMI-3 flow in both groups). In the confirmation phase, the 30-day MACCE-free rate was 95%. None of the 639 patients in the study required emergency surgery for failed primary PCI. Time to treatment with primary PCI can be significantly reduced when treating patients in a community hospital setting with off-site cardiac surgery backup as compared with transport for PCI to a referral center with on-site surgery. PCI at hospitals with off-site cardiac surgery backup can be considered as one of the needed strategies to improve access to primary PCI for a larger segment of the population basis, and can be delivered with a very favorable safety profile.

USE OF PERCUTANEOUS CORONARY INTERVENTION IN THE TREATMENT ST ELEVATION MYOCARDIAL INFARCTION

2020 ◽  
Vol 6 (1) ◽  
pp. 48-52
Author(s):  
Natal'ya Kirkina ◽  
Yu. Kulichenkova
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Survival Rate ◽  
Treatment Algorithm ◽  
Coronary Intervention ◽  
Time Frame ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
St Elevation

The analytical paper explores the role of percutaneous coronary intervention in the treatment ST elevation myocardial infarction according to studies over the last 5 years. The aim of the study is to consider the sequence of transdermal coronary intervention in the treatment algorithm, the time frame, and the 30-day and 1-year survival rate when using alternative treatments versus transdermal coronary intervention. In conclusion: percutaneous coronary intervention is a priority method of treating acute coronary syndrome with ST segment rise. In patients who found themselves in unaffordable centers for percutaneous coronary intervention, fibrinolysis in situ had a worse prognosis than patient transfer. Fibrinolysis followed by percutaneous coronary intervention is a reasonable alternative when primary percutaneous coronary intervention is not available, especially in patients with early manifestation of symptoms. When comparing patients with timely primary transcutaneous coronary intervention, late reperfusion after ST elevation myocardial infarction leads to reduced myocardial rescue and increased infarction size, hence the time frame is of great importance. In general, patients who underwent percutaneous coronary intervention in interbolinal movement had a higher survival rate for 1 year compared to patients receiving thrombolysis.

scholarly journals Clinical features, management and in-hospital outcome of ST elevation myocardial infarction (STEMI) in young adults under 40 years of age

2016 ◽  
Vol 72 (2) ◽  
Author(s):  
Seyed Kianoosh Hosseini ◽  
Abbas Soleimani ◽  
Abbas Ali Karimi ◽  
Saeed Sadeghian ◽  
Sirous Darabian ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Young Patients ◽  
Coronary Intervention ◽  
Clinical Findings ◽  
Hospital Death ◽  
Old Patients ◽  
St Segment Elevation ◽  
History Of

Objectives: This study was designed to evaluate the demographic and clinical findings and in-hospital management and outcome in patients with an acute ST-segment elevation myocardial infarction (STEMI). Material and methods: By review of the Cardiovascular Tehran Heart Center Registry (CVDTHCR), 2028 patients were found to have the acute STEMI. We compared the patients’ characteristics in 109 (5.4%) subjects ≤40 and 1919 subjects &gt; 40 years old. Results: The young patients had less diabetes, hypertension, dyslipidemia and history of MI or prior revascularization, and were more likely to be male (92.7% vs. 74%), smoker (58.7% vs. 31.7%) and have family history of CVD (50.5% vs. 23.4%). The young patients had higher prevalence of angiographically normal coronary artery (13.7% vs. 0.9%; p&lt;0.001). The young patients were more likely to undergo percutaneous coronary intervention (38.5% vs. 18.6%), whereas coronary artery bypass grafting was more common in the old ones (p&lt;0.001). In-hospital death was markedly different among young and old patients (0.9% and 6.1%, respectively; p&lt;0.01). Conclusion: In STEMI population, the risk profile, clinical findings and severity of coronary disease of the young differ substantially from the elderly counterparts. Young patients with STEMI have a favorable outcome compared with that in older patients.

scholarly journals The Comparison between the Outcomes of Streptokinase and Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction

2017 ◽  
Vol 1 (2) ◽  
pp. 33-50
Author(s):  
Zarnab Tariq ◽  
Majid Kaleem
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Clinical Findings ◽  
Primary Pci ◽  
Cross Sectional ◽  
Percutaneous Coronary ◽  
Better Than

AbstractBackground: To compare between the outcomes of streptokinase and primary PCI in acute myocardial infarction. The inappropriate treatment, misdiagnosis, contraindications of procedures can result in complications of procedures and increased mortality of patients. The present study aimed to compare between the outcomes of streptokinase and primary percutaneous coronary intervention in acute myocardial infarction patients to minimize the death rates in MI patients.Methodology: The descriptive study was conducted at Gulab Devi Chest Hospital. All the samples were collected from cardiac department. A Performa was designed for recording the risk factors, ST elevation, clinical findings and lab results of the patients.Results: In this cross-sectional study of 100 patients, the mean age was 51.02+ 10.956. Male gender was predominant. There were more chances (67.00%) of acute LVF in streptokinase and less chances (21.00%) in primary PCI. According to this study, there was more chances (67.00%) of cardiogenic shock in streptokinase and less chances (21.00%) in primary PCI. In this study, there were equal chances of stroke in streptokinase and primary PCI. In this study there were more chances (28.00%) of bleeding from any site in streptokinase and less chances (0%) in primary PCI. According to results there were chances (24.00%) of renal failure in streptokinase and less chances (0%) in primary PCI. There were more chances (9.43%) of rescue PCI in streptokinase and less chances in primary PCI. In this study, there were more chances of arrhythmias (26.41%) in streptokinase patients and less chances in primary PCI. In this study, there were also more chances of death (1.92%) in streptokinase and less chance in primary PCI. So according to my study primary PCI was better than streptokinase with less complications.Conclusion: Primary PCI was better than streptokinase to cure the myocardial infarction and better to minimize the complications after procedure.

No-reflow

2010 ◽  
pp. 536-541
Author(s):  
Julian Strange ◽  
Andreas Baumbach
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Gold Standard ◽  
Coronary Intervention ◽  
Recurrent Ischaemia ◽  
No Reflow ◽  
Percutaneous Coronary ◽  
Short Term Mortality

The no-reflow phenomenon is associated with significant cardiac consequences: poor functional recovery, ongoing or recurrent ischaemia, and increased short-term mortality. It occurs rarely in elective percutaneous interventions, but far more frequently in patients who present with acute myocardial infarction (AMI). It is in these patients, where primary percutaneous coronary intervention (PPCI) has become the gold standard that has most recently highlighted the phenomenon as it is commonly visualized in real time by the interventional cardiologist.

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