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Can we provide reperfusion therapy to all unselected patients admitted with acute myocardial infarction?
J M Juliard1, D Himbert, J L Golmard
1Cardiology Department, Hôpital Bichat, Paris, France.
Insights
Nearly all acute myocardial infarction patients can receive reperfusion therapy. This study achieved Thrombolysis in Myocardial Infarction (TIMI) grade 3 patency in 78% of patients using thrombolysis and percutaneous transluminal coronary angioplasty (PTCA).
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Early and complete reperfusion (TIMI grade 3 flow) is crucial in acute myocardial infarction (AMI).
- Thrombolysis is a common treatment but has limitations, including contraindications and ineffectiveness.
- Percutaneous transluminal coronary angioplasty (PTCA) offers an alternative or adjunctive reperfusion strategy.
Purpose of the Study:
- To determine the maximal rate of achieving Thrombolysis in Myocardial Infarction (TIMI) grade 3 patency in unselected acute myocardial infarction patients.
- To evaluate the effectiveness of a reperfusion strategy incorporating thrombolysis and PTCA.
Main Methods:
- A prospective study of 500 consecutive unselected AMI patients.
- Implementation of a patency-oriented treatment scheme including thrombolysis, rescue PTCA, and emergency PTCA.
- Angiographic assessment at 90 minutes to evaluate reperfusion status.
Main Results:
- 98% of patients received reperfusion therapy (thrombolysis, PTCA, or angiography).
- Angiographically proven early TIMI grade 3 patency was achieved in 78% of patients.
- Thrombolysis alone, emergency PTCA, and rescue PTCA were employed in 37%, 40%, and 15% of patients with TIMI grade 3 patency, respectively.
Conclusions:
- Reperfusion therapy is achievable in nearly all acute myocardial infarction patients.
- Rescue and direct PTCA are effective strategies for early reperfusion when thrombolysis is contraindicated or fails.
Objectives:
This study sought to assess the maximal rate of acute Thrombolysis in Myocardial Infarction (TIMI) grade 3 patency that can be achieved in unselected patients.
Background:
Early and complete (TIMI grade 3 flow) reperfusion is an important therapeutic goal during acute myocardial infarction. However, thrombolysis, although widely used, is often contraindicated or ineffective. The selective use of primary and rescue percutaneous transluminal coronary angioplasty (PTCA) may increase the number of patients receiving reperfusion therapy.
Methods:
A cohort of 500 consecutive unselected patients with acute myocardial infarction were prospectively treated using a patency-oriented scheme: Thrombolysis-eligible patients received thrombolysis (n = 257) and underwent 90-min angiography to detect persistent occlusion for treatment with rescue PTCA. Emergency PTCA (n = 193) was attempted in patients with contraindications to thrombolysis, cardiogenic shock or uncertain diagnosis and in a subset of patients admitted under "ideal conditions." A small group of patients (n = 38) underwent acute angiography without PTCA. Conventional medical therapy was used in 12 patients with contraindications to both thrombolysis and PTCA.
Results:
Ninety-eight percent of patients received reperfusion therapy (thrombolysis, PTCA or acute angiography), and angiographically proven early TIMI grade 3 patency was achieved in 78%. Among patients with TIMI grade 3 patency, thrombolysis alone was the strategy used in 37%, emergency PTCA in 40% and rescue PTCA after failed thrombolysis in 15%; spontaneous patency occurred in 8%.
Conclusions:
Reperfusion therapy can be provided to nearly every patient (98%) with acute myocardial infarction. Rescue and direct PTCA provided effective early reperfusion to patients in whom thrombolysis failed or was excluded.