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See Latest ArticlesRoutine early angioplasty after fibrinolysis for acute myocardial infarction
New England Journal of Medicine, 06/26/09
Cantor W et al. – Among high-risk pts with myocardial infarction with ST-segment elevation and who were treated with fibrinolysis, transfer for percutaneous coronary intervention (PCI) within 6 hrs after fibrinolysis was associated with significantly fewer ischemic complications than standard treatment.
Methods- Subjects: 1059 high-risk pts with myocardial infarction and ST-segment elevation receiving fibrinolytic therapy at centers with PCI capability
- Randomization to either standard treatment (including rescue PCI, if required, or delayed angiography) or a strategy of immediate transfer to another hospital and PCI within 6 hrs after fibrinolysis
- Aspirin, tenecteplase, and heparin or enoxaparin for all pts
- Concomitant clopidogrel recommended for all pts
- Primary endpoint: composite of death, reinfarction, recurrent ischemia, new or worsening congestive heart failure, or cardiogenic shock within 30 days
- Cardiac catheterization in 88.7% of standard treatment pts for median of 32.5 hrs after randomization and in 98.5% of routine early PCI pts for median of 2.8 hrs after randomization
- At 30 days, primary endpoint in 11.0% of routine early PCI pts and in 17.2% standard treatment pts
- No significant differences between groups for incidence of major bleeding
Today in Coronary Artery Disease...keeping you current
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