Determinants of improvement in epicardial flow and myocardial perfusion for ST elevation myocardial infarction; insights from TIMI 14 and InTIME-II.
Elliott M. Antman,Howard A. Cooper,Charles Michael Gibson,J.A. de Lemos,Carolyn H. McCabe,Robert P. Giugliano,P Coussement,Sean P. Murphy,Joel C Scherer,Keaven M. Anderson,F. Van de Werf,Eugene Braunwald +11 more
TLDR
The influence of time from symptoms on epicardial flow and STRES reinforces the need for increased efforts to reduce treatment delays in patients with ST elevation MI and suggests phase II trials evaluating new drug combinations should consider using a randomization scheme that stratifies patients based on infarct location and time from Symptoms.Abstract:
Background When evaluating new reperfusion regimens for ST elevation MI, it is important to adjust for factors that influence the likelihood of achieving normal epicardial flow and complete ST resolution.
Methods and Results A total of 610 patients from TIMI 14 contributed to the angiographic analyses. The electrocardiographic analyses were based on 544 patients from TIMI 14 and 763 patients from InTIME-II. For each hour from onset of symptoms to initiation of pharmacological reperfusion, the odds of achieving TIMI3 flow at 90min or complete ST resolution at 60–90min decreased significantly ( P =0·03). Anterior location of infarction was associated with a reduction in the odds of achieving TIMI3 flow or complete ST resolution. The use of abciximab as part of the reperfusion regimen significantly increased the odds of TIMI3 flow ( P =0·01) and ST resolution ( P <0·001). The fibrinolytic administered (alteplase, reteplase, lanoteplase) did not influence the odds of TIMI3 flow or ST resolution after adjusting for time to treatment, infarct location, and use of abciximab.
Conclusions The influence of time from symptoms on epicardial flow and STRES reinforces the need for increased efforts to reduce treatment delays in patients with ST elevation MI. The significant benefits of abciximab with respect to facilitation of epicardial and myocardial reperfusion are evident even after adjusting for time to treatment and infarct location. To adjust for determinants of success of reperfusion regimens, phase II trials evaluating new drug combinations should consider using a randomization scheme that stratifies patients based on infarct location and time from symptoms.read more
Citations
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Time-to-treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty.
Giuseppe De Luca,Arnoud W J van 't Hof,Menko-Jan de Boer,Jan Paul Ottervanger,Jan C.A. Hoorntje,A T Marcel Gosselink,Jan-Henk E. Dambrink,Felix Zijlstra,Harry Suryapranata +8 more
TL;DR: This study shows that in patients with STEMI treated by primary angioplasty prolonged ischaemic time is associated with impaired myocardial perfusion, larger infarct size, and higher 1-year mortality.
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Edema as a very early marker for acute myocardial ischemia: a cardiovascular magnetic resonance study.
TL;DR: It is provided the first evidence that T(2)-weighted cardiovascular magnetic resonance imaging of edema detects acute ischemic myocyte injury before the onset of irreversible injury.
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Effect of Low-Dose Intracoronary Alteplase During Primary Percutaneous Coronary Intervention on Microvascular Obstruction in Patients With Acute Myocardial Infarction: A Randomized Clinical Trial.
Peter McCartney,Hany Eteiba,Hany Eteiba,Annette Maznyczka,Annette Maznyczka,Margaret McEntegart,Margaret McEntegart,John P Greenwood,Douglas F Muir,Saqib Chowdhary,Anthony H. Gershlick,Clare Appleby,James Cotton,Andrew Wragg,Nick Curzen,Keith G. Oldroyd,Mitchell Lindsay,John Paul Rocchiccioli,Shaukat A,Richard Good,Stuart Watkins,Keith Robertson,Christopher J Malkin,Lynn Martin,Lynsey Gillespie,Thomas J. Ford,Mark C. Petrie,Mark C. Petrie,Peter W. Macfarlane,Tait Rc,Paul Welsh,Naveed Sattar,Robin A.P. Weir,Keith A.A. Fox,Ian Ford,Alex McConnachie,Colin Berry,Colin Berry +37 more
TL;DR: Among patients with acute STEMI presenting within 6 hours of symptoms, adjunctive low-dose intracoronary alteplase given during the primary percutaneous intervention did not reduce microvascular obstruction.
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Aborted myocardial infarction: a new target for reperfusion therapy.
TL;DR: The introduction of aborted infarction is suggested as an endpoint in clinical trials of ST-elevation acute coronary syndromes in order to salvage myocardium and improve both early and late clinical outcomes.
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Reteplase: a review of its use in the management of thrombotic occlusive disorders.
TL;DR: With its efficacy, and the ease of administration of the bolus doses potentially minimizing dosage errors when treatment is administered under time pressure, reteplase is a valuable option for pre- or in-hospital thrombolytic treatment in patients with STEMI, and is a useful thrombotic occlusive disorders described.
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