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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Predictors of infarct artery patency after prehospital thrombolysis: the multicentre, prospective, observational
1Department of Epidemiology, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Toulouse, France. bongard@cict.fr
Insights
Predictors of successful prehospital thrombolysis for ST-segment elevation myocardial infarction (STEMI) were identified. A nomogram using clinical and ECG data can predict coronary artery patency and guide triage for emergency angiography.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Research
Background:
- Prehospital thrombolysis is a critical intervention for ST-segment elevation myocardial infarction (STEMI).
- Predicting the success of thrombolysis is essential for timely patient management and resource allocation.
- Early assessment of infarct-related artery patency influences decisions regarding further interventions like emergency angiography.
Purpose of the Study:
- To identify predictors of early TIMI 3 flow (coronary artery patency) after prehospital thrombolysis in STEMI patients.
- To develop a predictive nomogram for stratifying patients who may benefit from emergency angiography.
- To evaluate these predictors in a real-world French population.
Main Methods:
- A multicentre, observational, prospective cohort study involving 997 STEMI patients across 79 French hospitals.
- Patients received prehospital thrombolysis within 6 hours of symptom onset, followed by angiography within 6 hours of treatment.
- Multivariable logistic regression was used to identify predictors of TIMI 3 flow, and a nomogram was constructed.
Main Results:
- Key predictors of TIMI 3 flow included current/previous smoking (OR=1.60), ≤5 leads with ST-segment elevation (OR=1.59), Killip class I (OR=1.96), chest pain relief (OR=1.62), and ST-segment resolution ≥70% (OR=1.76).
- A nomogram was developed incorporating these factors to predict the probability of achieving TIMI 3 flow.
- The study provides quantitative data on factors influencing thrombolysis success in a large, real-world cohort.
Conclusions:
- This study identifies significant predictors for successful prehospital thrombolysis in STEMI patients.
- The developed nomogram offers a practical tool for assessing coronary patency likelihood based on readily available clinical and electrocardiographic data.
- This tool can aid in identifying STEMI patients who require urgent angiography and potential rescue percutaneous coronary intervention.
Objective:
To identify predictors of early TIMI 3 flow patency of the infarct-related artery after prehospital thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI) using data from a "real-world" population, and to develop a nomogram for triaging patients to emergency angiography.
Design:
Multicentre, observational, prospective, cohort study.
Setting:
79 Hospitals in France with a prehospital mobile intensive care unit and a coronary care unit with 24 h access to coronary angiography.
Patients:
997 Patients with STEMI.
Interventions:
All patients received prehospital thrombolysis within 6 h of symptom onset and angiography was performed within 6 h of thrombolysis.
Main Outcome Measures:
Coronary patency (TIMI flow).
Results:
The median age of the population was 59 years and the sample comprised 18% women. After multivariable logistic regression analysis, predictors of TIMI 3 flow in the infarct-related artery were current/previous smoking (odds ratio (OR) = 1.60, 95% confidence interval 1.15 to 2.22), < or =5 leads with ST-segment elevation before thrombolysis (OR = 1.59, 1.12 to 2.25), Killip class I (OR = 1.96, 1.05 to 3.67), chest pain relief (OR = 1.62, 1.17 to 2.25) and ST-segment resolution > or =70% (OR = 1.76, 1.29 to 2.38). A nomogram was developed to assess the probability of TIMI 3 flow, according to smoking status, number of leads with ST elevation before thrombolysis, Killip class, chest pain relief and ST-segment resolution.
Conclusions:
This study provides quantitative data for predicting success of prehospital thrombolysis. The nomogram is a simple tool for predicting likelihood of coronary patency, based on clinical and electrocardiographic data. It may help to identify patients who require emergency angiography and rescue percutaneous coronary intervention.
