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Early vs Late Coronary Angiography and Intervention Following Thrombolytic Therapy; a Cohort Study

Bahareh Feizi, Shahram Taghdisi, Jalil Etemadi, Amir Hossein Feizi, Setareh Asgarzadeh, Sepideh Kamal
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Abstract

Introduction: The precise time of using percutaneous coronary intervention (PCI) after fibrinolytic therapy for maximum efficiency and minimum side effects is still undetermined. Therefore, the present study was designed to compare the outcome of myocardial infarction (MI) patients who underwent surgical intervention (angiography and PCI) within 48 hours of thrombolytic therapy or after that.

Methods: The present study is a prospective cohort study aiming to compare the occurrence of no-reflow phenomenon, unstable angina, bleeding during intervention, and one month major adverse cardiac outcomes (recurrent MI, need for repeating surgical intervention, and mortality) between MI patents undergoing surgical intervention within the first 48 hours of or after 48 hours of thrombolytic therapy.

Results: 90 patients with the mean age of 54.97 ± 10.54 were studied (86.67% male). 50 (56%) patients underwent surgical intervention within 48 hours and 40 (44%) after that. The 2 groups were not significantly different regarding baseline characteristics. No-reflow phenomenon in the < 48 hours group was about twice the > 48 hours group (OR = 0.35; 95% confidence interval: 0.14 – 0.92; p = 0.03), other outcomes were not significantly different. No case of mortality was seen in the 1 month follow up.

Conclusion: Based on the results of the present study, it seems that no-reflow phenomenon rate is significantly lower in patients undergoing surgical intervention after 48 hours of fibrinolytic therapy. The difference between the two groups regarding prevalence of major adverse cardiac outcomes was not statistically significant.

Keywords

Angiography; thrombolytic therapy; percutaneous coronary intervention; myocardial infarction; postoperative complications

References

Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The lancet. 2013;380(9859):2197-223.

Yusuf S, Reddy S, Ôunpuu S, Anand S. Global burden of cardiovascular diseases part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104(22):2746-53.

Grady D, Herrington D, Bittner V, Blumenthal R, Davidson M, Hlatky M, et al. Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). Jama. 2002;288(1):49-57.

Mathew V, Berger PB, Lennon RJ, Gersh BJ, Holmes DR. Comparison of percutaneous interventions for unstable angina pectoris in patients with and without previous coronary artery bypass grafting. The American journal of cardiology. 2000;86(9):931-7.

Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. The Lancet. 2003;361(9351):13-20.

de Lemos JA, Ettinger SM. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary. Journal of the American College of Cardiology. 2013;61(4).

Simoons M, Betriu A, Col J, Von Essen R, Lubsen J, Michel P, et al. Thrombolysis with tissue plasminogen activator in acute myocardial infarction: no additional benefit from immediate percutaneous coronary angioplasty. The Lancet. 1988;331(8579):197-203.

Rogers W, Baim D, Gore J, Brown B, Roberts R, Williams D, et al. Comparison of immediate invasive, delayed invasive, and conservative strategies after tissue-type plasminogen activator. Results of the Thrombolysis in Myocardial Infarction (TIMI) Phase II-A trial. Circulation. 1990;81(5):1457-76.

Collet J-P, Montalescot G, Le May M, Borentain M, Gershlick A. Percutaneous coronary intervention after fibrinolysis: a multiple meta-analyses approach according to the type of strategy. Journal of the American College of Cardiology. 2006;48(7):1326-35.

Erne P, Schoenenberger AW, Burckhardt D, Zuber M, Kiowski W, Buser PT, et al. Effects of percutaneous coronary interventions in silent ischemia after myocardial infarction: the SWISSI II randomized controlled trial. Jama. 2007;297(18):1985-91.

Steg PG, Kerner A, Van de Werf F, López-Sendón J, Gore JM, FitzGerald G, et al. Impact of in-hospital revascularization on survival in patients with non–ST-elevation acute coronary syndrome and congestive heart failure. Circulation. 2008;118(11):1163-71.

Kloner RA, Ganote CE, Jennings RB. The “no-reflow” phenomenon after temporary coronary occlusion in the dog. J Clin Invest. 1974;54(6):1496.

Simoons M, Topol E, Califf R, Werf F, Armstrong P, Aylward PE, et al. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. New England Journal of Medicine. 1993;329(10):673-82.

Cantor WJ, Burstein J, Choi R, Heffernan M, Dzavik V, Lazzam C, et al. Transfer for urgent percutaneous coronary intervention early after thrombolysis for ST-elevation myocardial infarction: the TRANSFER-AMI pilot feasibility study. Canadian Journal of Cardiology. 2006;22(13):1121-6.

Arnold AE, Serruys PW, Rutsch W, Simoons ML, De Bono DP, Tijssen JG, et al. Reasons for the lack of benefit of immediate angioplasty during recombinant tissue plasminogen activator therapy for acute myocardial infarction: a regional wall motion analysis. Journal of the American College of Cardiology. 1991;17(1):11-21.

Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. New England Journal of Medicine. 2005;352(12):1179-89.

De Luca G, Suryapranata H, Stone GW, Antoniucci D, Tcheng JE, Neumann F-J, et al. Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. Jama. 2005;293(14):1759-65.

Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2013;61(23):e179-e347.

Di Mario C, Dudek D, Piscione F, Mielecki W, Savonitto S, Murena E, et al. Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined Abciximab REteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI): an open, prospective, randomised, multicentre trial. The Lancet. 2008;371(9612):559-68.

Fernández-Avilés F, Alonso JJ, Peña G, Blanco J, Alonso-Briales J, López-Mesa J, et al. Primary angioplasty vs. early routine post-fibrinolysis angioplasty for acute myocardial infarction with ST-segment elevation: the GRACIA-2 non-inferiority, randomized, controlled trial. European heart journal. 2007;28(8):949-60.

Armstrong PW, Gershlick A, Goldstein P, Wilcox R, Danays T, Bluhmki E, et al. The strategic reperfusion early after myocardial infarction (STREAM) study. American heart journal. 2010;160(1):30-5. e1.

Edmond JJ, Juergens CP, French JK. The pharmaco-invasive approach to STEMI: when should fibrinolytic-treated patients go to the “cath lab”? Postgraduate medical journal. 2009;85(1004):331-4.

Capodanno D, Dangas G. Facilitated/pharmaco-invasive approaches in STEMI. Current cardiology reviews. 2012;8(3):177.

van’t Hof AW, de Vries ST, Dambrink J-HE, Miedema K, Suryapranata H, Hoorntje JC, et al. A comparison of two invasive strategies in patients with non-ST elevation acute coronary syndromes: results of the Early or Late Intervention in unStable Angina (ELISA) pilot study. European Heart Journal. 2003;24(15):1401-5.




DOI: http://dx.doi.org/10.22037/emergency.v5i1.15214

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