Thrombolysis followed by early revascularization: an effective reperfusion strategy in real world patients with ST-elevation myocardial infarction.

Several trials suggested superiority of primary percutaneous coronary intervention (PPCI) angioplasty over thrombolysis in patients with ST-elevation myocardial infarction (STEMI), but many trials were characterized by low rates of early revascularization in patients treated with initial thrombolysis. We tested the hypothesis that in patients with hemodynamically stable STEMI, initial thrombolysis followed by an active early rescue/definitive revascularization strategy could achieve salutary short- and long-term outcomes. A prospective registry documented all 212 STEMI patients who received initial thrombolytic therapy over a 2-year period in a single medical center. Median patient age was 58 (range: 29-92) years, 47 (22%) patients were aged >70 years and 18 (8%) >80 years. Fifty-two (25%) patients underwent rescue angioplasty <6 h after thrombolysis for inadequate clinical reperfusion. In 194/212 (92%) patients, coronary angiography was performed during initial hospitalization, PCI in 168 (79%), and coronary bypass surgery in 18 (8%). Thirty-day mortality was 4.7% and 1-year mortality 6.7%. Mortality was not related to diabetes mellitus, hypertension, anterior infarction location, fibrin-specific thrombolytic drug or rescue PCI. By multivariate analysis, in-hospital definitive angiography/revascularization (p < 0.0001) and TIMI risk score >3 on admission (p < 0.01) were significant independent predictors of both 30 day and 12 month outcome. Initial thrombolysis was useful and effective in real-world STEMI patients when coupled with an aggressive policy of rescue angioplasty and early in-hospital revascularization. Outcomes compared favorably with those reported for PPCI trials. The adverse prognosis in older patients with higher TIMI risk score suggests that in those patients alternative initial treatment strategies such as PPCI should be considered.

Jaffe R ，Halon DA ，Karkabi B ，Goldstein J ，Rubinshtein R ，Flugelman MY ，Lewis BS ... -  《-》

Treatment of acute ST-segment elevation myocardial infarction in West Pomerania province of Poland. Comparison between primary coronary intervention and thrombolytic therapy.

Dryja T ，Kornacewicz-Jach Z ，Goracy J ，Przybycień K ，Jodko L ，Skowronek A ，Kurowski M ，Zinka E ... -  《Kardiologia Polska》

Comparison of thrombolysis followed by broad use of percutaneous coronary intervention with primary percutaneous coronary intervention for ST-segment-elevation acute myocardial infarction: data from the french registry on acute ST-elevation myocardial inf

Danchin N ，Coste P ，Ferrières J ，Steg PG ，Cottin Y ，Blanchard D ，Belle L ，Ritz B ，Kirkorian G ，Angioi M ，Sans P ，Charbonnier B ，Eltchaninoff H ，Guéret P ，Khalife K ，Asseman P ，Puel J ，Goldstein P ，Cambou JP ，Simon T ，FAST-MI Investigators ... -  《-》

Is transport with platelet GP IIb/IIIa inhibition for primary percutaneous coronary intervention more efficient than on-site thrombolysis in patients with STEMI admitted to community hospitals? Randomised study. Early results.

Dobrzycki S ，Mezyński G ，Kralisz P ，Prokopczuk P ，Nowak K ，Kochman W ，Zuk J ，Bachórzewska-Gajewska H ，Sawicki Z ，Poniatowski B ，Korecki J ，Musiał WJ ... -  《Kardiologia Polska》

Early reperfusion and late clinical outcomes in patients presenting with acute myocardial infarction randomly assigned to primary percutaneous coronary intervention or streptokinase.

Berrocal DH ，Cohen MG ，Spinetta AD ，Ben MG ，Rojas Matas CA ，Gabay JM ，Magni JM ，Nogareda G ，Oberti P ，Von Schulz C ，Doval H ，Bazzino OO ，Cagide A ，Oliveri R ，Grinfeld LR ... -  《-》