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[Immediate delayed coronary angioplasty after intravenous thrombolysis in myocardial infarction. Prospective study]
1Service de cardiologie A, CHU Timone, Marseille.
Insights
Early or delayed percutaneous transluminal coronary angioplasty (PTCA) after thrombolysis for acute myocardial infarction showed no significant difference in outcomes. Both strategies achieved high therapeutic success rates during hospitalization.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) requires timely reperfusion therapy.
- Intravenous thrombolysis is a primary treatment for AMI.
- Percutaneous transluminal coronary angioplasty (PTCA) is an option for patients with residual stenosis after thrombolysis.
Purpose of the Study:
- To determine the optimal timing for performing percutaneous transluminal coronary angioplasty (PTCA) following intravenous thrombolysis in patients with acute myocardial infarction (AMI).
Main Methods:
- A prospective randomized study involving 50 patients with AMI treated with intravenous thrombolysis.
- Patients underwent coronary angiography 24-72 hours post-thrombolysis.
- Participants were divided into early PTCA (24-72 hours) and delayed PTCA (8-10 days) groups.
- Heparin and aspirin were administered during hospitalization.
- Recurrent ischemia (RI) was monitored and treated with PTCA.
Main Results:
- PTCA was technically feasible in a significant portion of patients.
- In the early PTCA group (n=25), 24 had successful PTCA with 2 incidents of recurrent ischemia.
- In the delayed PTCA group (n=25), 4 episodes of RI occurred within 24 hours; 15 of 20 eligible patients underwent successful PTCA later.
- No statistically significant difference in primary success or recurrent ischemia rates between early and delayed PTCA strategies was observed.
- Therapeutic success was achieved in 22/25 patients in the early group and 19/25 in the delayed group.
Conclusions:
- Both early (24-72 hours) and delayed (8-10 days) percutaneous transluminal coronary angioplasty (PTCA) following thrombolysis for acute myocardial infarction (AMI) are effective strategies.
- There is no statistically significant difference in therapeutic success or recurrent ischemia between early and delayed PTCA.
- The timing of PTCA can be individualized based on patient factors and clinical course.
Abstract:
A prospective randomized study was undertaken in 50 patients treated with intravenous thrombolysis (streptokinase, tissue plasminogen activator, association of the two thrombolytics) for acute myocardial infarction to determine the best time to perform percutaneous transluminal coronary angioplasty (PTCA). Coronary angiography was carried out 24 to 72 hours after thrombolysis. This investigation allowed identification of the patients in whom PTCA was technically feasible. These patients were then divided into two groups: Group A: early PTCA (24-72 hours) and Group B: delayed PTCA (8-10 days). During the hospital period, the patients were prescribed heparin therapy and aspirin. Recurrent ischemia (RI) was investigated and treated by PTCA. The criteria of success of strategies A and B were a primary success of PTCA and no RI during the hospital period. Coronary angiography was performed in 108 successive patients of whom 50 were included for the comparative trial, 25 in Group A and 25 in Group B. In group A, PTCA was successful in 24 cases and there were 2 incidents of RI (6 hours and 12 days). In Group B, 4 episodes of RI were observed in the 24 hours following coronary angiography: after 10 days, 15 of the 20 patients with uncomplicated courses underwent PTCA; 1 patient refused consent, 2 regressions of stenosis and 3 asymptomatic reocclusions were observed. A primary success of PTCA was obtained in 13 of the 15 patients. There was no statistically significant difference between the results of the strategies adopted in Groups A and B. A therapeutic success was obtained in 22 of the 25 patients in Group A, and 19 of the 25 patients in Group B.(ABSTRACT TRUNCATED AT 250 WORDS)