Showing papers by "Stefan Martinoff published in 2004"

Early administration of reteplase plus abciximab vs abciximab alone in patients with acute myocardial infarction referred for percutaneous coronary intervention: a randomized controlled trial.

Abstract: ContextThe optimal pharmacological strategy for bridging the delay between admission and performance of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (MI) is not known.ObjectiveTo assess whether early administration of reteplase plus abciximab produces better results compared with abciximab alone in patients with acute MI referred for PCI.Design, Setting, and PatientsOpen-label, randomized controlled study conducted from May 3, 2001, through June 2, 2003, of 253 patients who were admitted to 13 community hospitals without catheterization facilities (n = 186) and to 5 hospitals with catheterization facilities (n = 67), with the diagnosis of an ST-segment elevation acute MI within 12 hours from onset of symptoms.InterventionsPatients received intravenously either the combination of a half-dose reteplase (two 5-U boluses, 30 minutes apart) with a standard dose of abciximab (0.25 mg/kg bolus, 0.125 µg/kg per minute infusion [maximum 10 µg/min for 12 hours]) or the standard dose of abciximab alone; all patients were then transferred for PCI.Main Outcome MeasureFinal infarct size according to a single-photon emission computed tomography study with technetium Tc 99m sestamibi performed between 5 and 10 days after randomization in 228 patients (90.1% of entire sample).ResultsOf the 253 patients enrolled, 125 were assigned to reteplase plus abciximab and 128 to abciximab alone. The median (interquartile range) of the final infarct size of the left ventricle was 13.0% (3.0%-28.0%) in the reteplase plus abciximab group and 11.5% (3.0%-26.3%) in the abciximab-alone group (P = .81). The mean difference in final infarct size of left ventricle between the reteplase plus abciximab group and the abciximab group was 1.3% (95% confidence interval [CI], –3.1% to 5.7%). Within 6 months after randomization, the composite secondary end point of death, recurrent MI, or stroke occurred in 8 patients (6.4%) in the reteplase plus abciximab group and 6 patients (4.7%) in the abciximab group (relative risk, 1.4; 95% CI, 0.5-3.9; log-rank P = .56). Major bleeding complications were observed in 7 patients (5.6%) in the reteplase plus abciximab group and 2 patients (1.6%) in the abciximab group (P = .16).ConclusionEarly administration of reteplase plus abciximab does not lead to a reduction of infarct size compared with abciximab alone in patients with acute MI referred for PCI.

Prognostic value of myocardial salvage achieved by reperfusion therapy in patients with acute myocardial infarction

Abstract: Myocardial salvage assessed by 99mTc-sestamibi scintigraphy is a marker of myocardial tissue reperfusion in patients with acute myocardial infarction. The prognostic value of myocardial salvage index in patients with acute myocardial infarction after reperfusion therapy has not, however, been investigated. Methods: We analyzed 765 patients with acute myocardial infarction randomized to treatment by coronary stenting (383 patients), primary coronary angioplasty (251 patients), or thrombolysis (131 patients) in the setting of 3 randomized trials. Initial (before reperfusion therapy) and follow-up (7–14 d after reperfusion therapy) scintigraphic examinations were performed to assess the initial perfusion defect, final infarct size, and salvage index. Patients were categorized into 2 groups defined by the median salvage index (0.5): the group with salvage index

CLINICAL RESEARCH Interventional Cardiology A Randomized Trial Comparing Myocardial Salvage Achieved by Coronary Stenting Versus Balloon Angioplasty in Patients With Acute Myocardial Infarction Considered Ineligible for Reperfusion Therapy

Abstract: OBJECTIVES We assessed myocardial salvage achieved by reperfusion with percutaneous coronary inter-ventions (PCI) and compared stenting with balloon angioplasty (PTCA) in patients withacute myocardial infarction (AMI) ineligible for thrombolysis.BACKGROUND A substantial proportion of patients with AMI are currently considered ineligible forthrombolysis, and reperfusion treatment is frequently not recommended for them. It is notknown whether these patients benefit from PCI.METHODS The Stent or PTCA for Occluded Coronary Arteries in Patients with Acute MyocardialInfarction Ineligible for Thrombolysis (STOPAMI-3) trial, a randomized, open-label study,included 611 patients with AMI who were ineligible for thrombolysis (lack of ST-segmentelevation on the electrocardiogram, late presentation 12 h after symptom onset, andcontraindications to thrombolysis). Patients were randomly assigned to receive eithercoronary artery stenting (n 305) or PTCA (n 306). Scintigraphic myocardial salvageindex (proportion of the initial myocardial perfusion defect that was salvaged by reperfusion)was the primary end point of the study.RESULTS A considerable myocardial salvage was achieved with both stenting and PTCA. In patientsassigned to receive stenting, the median size of the salvage index was 0.54 (25th and 75thpercentiles, 0.29 and 0.87), as compared with a median of 0.50 (25th and 75th percentiles,0.26 and 0.82) in the group assigned to receive PTCA (p 0.20). Mortality at six monthswas 8.2% in the group of patients assigned to receive stenting and 9.2% in the group ofpatients assigned to receive PTCA (p 0.69).CONCLUSIONS Patients with AMI who are currently considered ineligible for thrombolysis by conventionalguidelines may greatly benefit from primary PCI. The benefit seems to be comparable whena strategy of stenting is compared with a strategy of PTCA in these patients. (J Am CollCardiol 2004;43:734–41) © 2004 by the American College of Cardiology Foundation

Multislice Computed Tomography in Complex Pulmonary Atresia After Stent Implantation

Abstract: A 37-year-old severely cyanotic man with unoperated pulmonary atresia, ventricular septal defect, and aortopulmonary collateral vessels was referred for invasive assessment in January 1995. In 2 of 3 larger aortopulmonary collaterals, cardiac catheterization depicted a circumscript stenosis near the origin from the aorta. Because of the patient’s severe cyanosis and unsuitability for corrective surgery, stents were …

Coral as a substitute for bone grafts in delayed sternal closure in neonates.

Abstract: A 20-day-old boy underwent open heart surgery at 9 days of age because of complex heart disease. The thorax was initially closed with a Gore-Tex patch. After 11 days, a second operation was performed for final sternal closure. The Hancock conduit was bulging out from the thoracic cavity and the sternum could not be closed without compromising cardiac output. A coralline hydroxyapatite block was interposed to enlarge the thoracic space [1]. It is a bone-like material Fig. 1 Chest radiograph shows hyperdense coral hydroxyapatite and Hancock valve ring