Prospective evaluation of clinical outcomes after acute ST-elevation myocardial infarction in patients who are ineligible for reperfusion therapy: preliminary results from the TETAMI registry and randomized trial
| Autor: | Marc Cohen, Frans Maritz, Maria Krzemińska-Pakuła, Carole Hecquet, Enrique P. Gurfinkel, Jose Santopinto, Kurt Huber, Luc Vittori, Ari Timerman, Gian Franco Gensini |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Bundle-Branch Block Myocardial Infarction Myocardial Reperfusion Revascularization law.invention Electrocardiography Reperfusion therapy Randomized controlled trial Double-Blind Method Fibrinolytic Agents law Physiology (medical) Internal medicine Antithrombotic medicine Humans Myocardial infarction Prospective Studies Registries Enoxaparin Aged business.industry Heparin Cardiogenic shock Age Factors Anticoagulants Tirofiban Middle Aged medicine.disease Surgery Survival Rate Treatment Outcome Conventional PCI Cardiology Tyrosine Drug Therapy Combination Female Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Circulation. 108(16 Suppl 1) |
| ISSN: | 1524-4539 |
| Popis: | Background— Treatment with lytics or primary percutaneous coronary interventions (PCI) reduces the mortality rate of patients with ST-elevation myocardial infarction (STEMI) presenting within 12 hours. Patients presenting >12 hours are generally considered to be ineligible for reperfusion therapy, and there are currently no specific treatment recommendations for this subgroup. Methods— All patients with STEMI Results and Conclusion— There were 2,737 patients who presented with STEMI or a new left branch bundle block (LBBB), of which 1,654 (60%) presented ≤12 hours. There were 1,196 (72%) of 1,654 patients who received reperfusion therapy. There were 458 (28%) of the 1,654 patients deemed “ineligible” for reperfusion, mostly because of a contraindication to lytics or for being “too old.” In contrast, 1,083 (40%) of 2,737 patients presented >12 hours. Apart from 34 of these patients who had a stuttering infarction and were referred for reperfusion, the remaining patients did not receive reperfusion therapy. Registry patients who received reperfusion therapy, compared with TETAMI randomized patients (all of whom received antithrombotic therapy) and registry patients who did not receive reperfusion, were younger (61 years versus 63 years and 67 years), were more likely to be male (78% versus 73% and 63%), and had persistent ST-segment elevation as opposed to LBBB or Q waves. Registry patients who received reperfusion therapy had better clinical outcomes, even after adjusting for admission Killip class, compared with TETAMI randomized patients and registry patients who did not receive reperfusion therapy. TETAMI randomized patients had better outcomes than registry patients who did not receive reperfusion therapy. The major obstacle to expanding the delivery of reperfusion therapy to patients with STEMI is the large fraction of patients who present too late for reperfusion therapy. Examination of prospectively gathered data on STEMI patients who are ineligible for reperfusion may help optimize their treatment. |
| Databáze: | OpenAIRE |
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