The most often used reperfusion strategy for patients with STEMI is still thrombolysis, but it is not the end of treatment. The aim of this paper was to show whether routine in-hospital coronary angiography and subsequent revascularization (percutaneous or surgery) after thrombolysis improve an one-year prognosis in patients with STEMI. The study involved 155 patients, 29-79 years old, with first STEMI. They were treated with fibrinolytic, aspirin, and enoxaparin. Group I (102 patients) underwent coronary angiography on approximately the 5th day of hospitalization, then percutaneously or surgically revascularized if considered appropriate. In group II (53 patients), in-hospital angiography was not done. Mortality, reinfarction, angina and left ventricular systolic function were analyzed during one-year period. Patients in group II were older, they received clopidogrel and statin less frequently and ACE inhibitors more frequently. The groups were significantly different regarding the in-hospital (3% vs. 15%, p=0.008) and one-year mortality (2% vs. 11.1%, p=0.03). There was a numeric trend for higher frequency of reinfarction in group II (3% vs. 11.1%, p=0.06). After one year, more patients in group II had angina (2.9% vs. 13.2%, p=0.03). In hospital, the groups had similar EF (54% vs. 51.2%, ns), but after one year EF in group I was higher (55.2% vs. 47.6%, p=0.02). Multivariable analysis adjusted for age and differences in drug therapy showed that the lack of routine elective coronary angiography and revascularization is an independent predictor of one-year mortality (RR 4.7, p=0.019) and independent predictor of combined mortality, reinfarction and angina (RR 3.2, p=0.028). Routine coronary angiography and revascularization after thrombolysis improve in-hospital and oneyear survival, decrease the frequency of reinfarction and angina, and improve the left ventricular function.
Fernandez-Aviles F, Alonso J, Castro-Beiras A, N V, Blanco J, J. AB, et al. Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conserva tive approach for acute myocardial infarction with ST segment elevation (GRACIA-1): a randomised contro lled trial. Lancet. 2004;364:1045–53.
2.
Yousef ZR, Marber MS, Redwood. Late opening of the infarct related artery: an open or shut case? Heart. 2005;91:561–2.
3.
Agati L, Funaro S, Madonna M, Sardella G, Garramone B, Galiuto L. Does coronary angioplasty after timely thrombolysis improve microvascular perfusion and left ventricular function after acute myocardial infarction? Am Heart J. 2007;154:151–7.
4.
Lundergan FC, Reiner SJ, Ross MA, PACT Investigators. How long is too long? Association of time delay to successful reperfusion and ventricular function outcome in acute myocardial infarction: the case for thrombolytic therapy before planned angioplasty for acute myocardial infarction. Am Heart J. 2002;144:456–62.
5.
Antman ME. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction. Cir culation. 2008;117:296–329.
6.
Collet JP, Montalescot G, Le-May M, Borentain M, Gershlick A. Percutaneous coronary intervention after fibrinolysis. A multiple meta-analyses approach acco rding to the type of strategy. J Am Coll Cardiol. 2006;48:1326–35.
7.
Steg PG, Thuaire C, Himbert D, Carrie D, Champagne S, Coisne D, et al. DECOPI (DEsobstruction COronaire en Post-Infarctus): a randomized multicentre trial of occluded artery angioplasty after acute myocardial infarction. Eur Heart J. 2004;25:2187–94.
8.
Hochman SJ, Lamas AG, Buller EC, Dzavik V, Reynolds RH, Abramsky JS, et al. Coronary intervention for persi stent occlusion after myocardial infarction. N Engl J Med. 2006;355:2395–407.
9.
Zeymer U, Uebis R, Vogt A, Glunz HG, Vohringer HF. Harmjanz D, et al for the ALKK-Study Group. Rando mized comparison of percutaneous transluminal coro nary angioplasty and medical therapy in stable survi vors of acute myocardial infarction with single vessel disease. Circulation. 2003;108:1324–8.
10.
McClelland JA, Owens GC, Walsh JS, Mc Carty D, Mathew T, Stevenson M, et al. Percutaneous coronary intervention and 1 year survival in patients treated with fibrinolytic therapy for acute ST-elevation myocardial infarction. Europ Heart J. 2005;26:544–8.
11.
Armstrong WP, Committee WESTS. A compa rision of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous inter vention early after ST-elevation myocardial infarction: the WEST (Wich Early ST-elevation myocardial infar ction Therapy) study. Eur Heart J. 2006;27:1530–8.
12.
Scheller B, Hennen B, Hammer B, Walle J, Hofer C, Hilpert V, et al. Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction. J Am Coll Cardiol. 2003;42:634–41.
13.
Fernandez-Aviles F, Alonso JJ, Pena G, Blanco J, Alonso-Briales J. Lopez-Mesa J, et al for the GRACIA 2 Investigators. Primary angioplasty vs. early routine post-fibrinolysis angioplasty for acute myocardial in farction with ST-segment elevation: the GRACIA-2 non-inferiority randomised, controlled trial. Eur Heart J. 2007;28:949–60.
14.
Abbate A, Agostoni P, Biondi-Zoccai GLG. ST-segment elevation acute myocardial infarction: reperfusion at any cost? Eur Heart J. 2005;26:1813–5.
15.
Gupta M, Chang WC, Van-de-Werf F, Granger BC, Midodzi W. Barbash G, et al for the ASSENT-2 inve stigators. International differences in in-hospital reva scularization and outcomes following acute myocar dial infarction. A multilevel analysis of patients in ASSENT-2. Eur Heart J. 2003;24:1640–50.
16.
Chen ZM, Jiang LX, Chen YP. for the COMMIT collaborative group. Addition of clopidogrel to aspirin in 45852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005;366:1607–21.
17.
Sabatine SM, Cannon PC, Gibson CM. for the CLARITY-TIMI 28 investigators. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infar ction with ST-segment elevation. N Engl J Med. 2005;352:1179–89.
18.
Antman EM, Anbe DT, PW A. ACC/AHA guidelines for the management of patients with ST elevation myocardial: a report of the American Colle ge of Cardiology/American Heart Association Task For ce on Practice Guidelines.
19.
Silber S. et al for the task force for percutaneous coronary interventions of the European Society of Cardiology. Guidelines for percutaneous coronary in terventions. Eur Heart J. 2005;26:804–47.
20.
Bassand JP, Danchin N, Filippatos G, Gitt A, Hamm C, Silber S, et al. Implementation of reperfusion the rapy in acute myocardial infarction. A policy state ment from the European Society of Cardiology. Eur Heart J. 2005;26:2733–41.
21.
The future of treatment for ST-elevation myocardial infarction. Circulation. 2004;109:2480–6.
22.
Melandri G. The obsession with primary angioplasty. Circulation. 2003;108:162.
23.
Eagle KA, Nallamothu BK, Mehta RH. for the Global Registry of Acute Coronary Events (GRACE) In vestigators. Trends in acute reperfusion therapy for ST segment elevation myocardial infarction from 1999 to 2006: we are getting better but we have got a long way to go. Eur Heart J. 2008;29:609–17.
24.
Nallamothu B, Fox AAK, Kennelly MB, Werf F, Gore MJ, Steg G, et al. Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. In: The Global Registry of Acute Coronary Events BMJ 2007.
25.
Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 ran domised trials. Lancet. 2003;361:13–20.
26.
Giugliano PR, Braunwald E. Selecting the best reper fusion strategy in ST-elevation myocardial infarction. It’s all a matter of time. Circulation. 2003;108:2828–30.
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