Comparison of angioplasty with infusion of tirofiban or abciximab and with implantation of sirolimus-eluting or uncoated stents for acute myocardial infarction: the MULTISTRATEGY randomized trial.
Marco Valgimigli,Gianluca Campo,Gianfranco Percoco,Leonardo Bolognese,Corrado Vassanelli,Salvatore Colangelo,Nicoletta De Cesare,Alfredo E. Rodriguez,Maurizio Ferrario,Raúl Moreno,Tommaso Piva,Imad Sheiban,Giampaolo Pasquetto,Francesco Prati,Marco Stefano Nazzaro,Giovanni Parrinello,Roberto Ferrari +16 more
TLDR
Tirofiban therapy was associated with noninferior resolution of ST-segment elevation at 90 minutes following coronary intervention, whereas sirolimus-eluting stent implantation wasassociated with a significantly lower risk of major adverse cardiac events than uncoated stents within 8 months after intervention.Abstract:
Context Abciximab infusion and uncoated-stent implantation is a complementary treatment strategy to reduce major adverse cardiac events in patients undergoing angioplasty for ST-segment elevation myocardial infarction (STEMI). It is uncertain whether there may be similar benefits in replacing abciximab with high-dose bolus tirofiban. Similarly, the use of drug-eluting stents in this patient population is currently discouraged because of conflicting results on efficacy reported in randomized trials and safety concerns reported by registries. Objective To evaluate the effect of high-dose bolus tirofiban and of sirolimus-eluting stents as compared with abciximab infusion and uncoated-stent implantation in patients with STEMI undergoing percutaneous coronary intervention. Design, Setting, and Patients An open-label, 2 × 2 factorial trial of 745 patients presenting with STEMI or new left bundle-branch block at 16 referral centers in Italy, Spain, and Argentina between October 2004 and April 2007. Interventions High-dose bolus tirofiban vs abciximab infusion and sirolimus-eluting stent vs uncoated stent implantation. Main Outcome Measures For drug comparison, at least 50% ST-segment elevation resolution at 90 minutes postintervention with a prespecified noninferiority margin of 9% difference (relative risk, 0.89); for stent comparison, the rate of major adverse cardiac events, defined as the composite of death from any cause, reinfarction, and clinically driven target-vessel revascularization within 8 months. Results ST-segment resolution occurred in 302 of 361 patients (83.6%) who had received abciximab infusion and 308 of 361 (85.3%) who had received tirofiban infusion (relative risk, 1.020; 97.5% confidence interval, 0.958-1.086; P Conclusions In patients with STEMI undergoing percutaneous coronary intervention, compared with abciximab, tirofiban therapy was associated with noninferior resolution of ST-segment elevation at 90 minutes following coronary intervention, whereas sirolimus-eluting stent implantation was associated with a significantly lower risk of major adverse cardiac events than uncoated stents within 8 months after intervention. Trial Registration clinicaltrials.gov Identifier: NCT00229515Published online March 30, 2008 (doi:10.1001/jama.299.15.joc80026).read more
Citations
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2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction
Patrick T. O'Gara,Frederick G. Kushner,Deborah D. Ascheim,Donald E. Casey,Mina K. Chung,James A. de Lemos,Steven M. Ettinger,James C. Fang,Francis M. Fesmire,Barry A. Franklin,Christopher B. Granger,Harlan M. Krumholz,Jane A. Linderbaum,David A. Morrow,L. Kristin Newby,Joseph P. Ornato,Narith N. Ou,Martha J. Radford,Jacqueline E. Tamis-Holland,Carl L. Tommaso,Cynthia M. Tracy,Y. Joseph Woo,David Zhao +22 more
TL;DR: The 2017-18 FAHA/FACC/FAHA Education and Research Grants will be focused on advancing the profession’s understanding of central nervous system disorders and the management of post-traumatic stress disorder.
Journal ArticleDOI
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary
Patrick T. O'Gara,Frederick G. Kushner,Deborah D. Ascheim,Donald E. Casey,Mina K. Chung,James A. de Lemos,Steven M. Ettinger,James C. Fang,Francis M. Fesmire,Barry A. Franklin,Christopher B. Granger,Harlan M. Krumholz,Jane A. Linderbaum,David A. Morrow,L. Kristin Newby,Joseph P. Ornato,Narith N. Ou,Martha J. Radford,Jacqueline E. Tamis-Holland,Carl L. Tommaso,Cynthia M. Tracy,Y. Joseph Woo,David Zhao +22 more
TL;DR: This guideline makes more liberal use of summary recommendation tables (with references that support LOE) to serve as a quick reference (e.g. in PubMed), and more liberalUse of summaryRecommendations.
Journal ArticleDOI
2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Frederick G. Kushner,Mary M. Hand,Sidney C. Smith,Spencer B. King,Jeffrey L. Anderson,Elliott M. Antman,Steven R. Bailey,Eric R. Bates,James C. Blankenship,Donald E. Casey,Lee A. Green,Judith S. Hochman,Alice K. Jacobs,Harlan M. Krumholz,Douglass A. Morrison,Joseph P. Ornato,David L. Pearle,Eric D. Peterson,Michael A. Sloan,Patrick L. Whitlow,David O. Williams +20 more
TL;DR: A primary challenge in the development of clinical practice guidelines is keeping pace with the stream of new data on which recommendations are based as discussed by the authors, and the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) is to respond promptly to new evidence.
Journal ArticleDOI
2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update)†
Frederick G. Kushner,Mary M. Hand,Sidney C. Smith,Spencer B. King,Jeffrey L. Anderson,Elliott M. Antman,Steven R. Bailey,Eric R. Bates,James C. Blankenship,Donald E. Casey,Lee A. Green,Judith S. Hochman,Alice K. Jacobs,Harlan M. Krumholz,Douglass A. Morrison,Joseph P. Ornato,David L. Pearle,Eric D. Peterson,Michael A. Sloan,Patrick L. Whitlow,David O. Williams +20 more
TL;DR: A primary challenge in the development of clinical practice guidelines is keeping pace with the stream of new data on which recommendations are based as discussed by the authors, and the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) is to respond promptly to new evidence.
Journal ArticleDOI
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Patrick T. O'Gara,Frederick G. Kushner,Deborah D. Ascheim,Donald E. Casey,Mina K. Chung,James A. de Lemos,Steven M. Ettinger,James C. Fang,Francis M. Fesmire,Barry A. Franklin,Christopher B. Granger,Harlan M. Krumholz,Jane A. Linderbaum,David A. Morrow,L. Kristin Newby,Joseph P. Ornato,Narith N. Ou,Martha J. Radford,Jacqueline E. Tamis-Holland,Carl L. Tommaso,Cynthia M. Tracy,Y. Joseph Woo,David Zhao +22 more
TL;DR: The 2017-18 FAHA/FACC/FAHA Education and Research Grants will be focused on advancing the profession’s understanding of central nervous system disorders and the management of post-traumatic stress disorder.
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Comparison of two platelet glycoprotein IIb/IIIa inhibitors, tirofiban and abciximab, for the prevention of ischemic events with percutaneous coronary revascularization.
Eric J. Topol,David J. Moliterno,Howard C. Herrmann,Eric R. Powers,Cindy L. Grines,David J. Cohen,Eric A. Cohen,Michel E. Bertrand,Franz-Josef Neumann,Gregg W. Stone,Peter M. DiBattiste,Laura A. Demopoulos,Target Investigators. Do Tirofiban,ReoPro Give Similar Efficacy Trial +13 more
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