Pharmacoinvasive therapy for ST elevation myocardial infarction in China: a pilot study
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Abstract
Most patients with acute ST-elevation myocardial infarction (STEMI) cannot receive timely primary percutaneous coronary intervention (PCI) because of lack of facilities or delays in patient transfer or catheterization team mobilization. In these patients, early routine post-thrombolysis PCI might be a reasonable, useful strategy. This study investigated feasibility and safety of early PCI after successful half-dose alteplase reperfusion in a Chinese population. Patients with STEMI received half-dose alteplase if expected time delay to PCI was ≥90 min. Patients who reached clinical criteria of successful thrombolysis reperfusion were recommended to undergo diagnostic angiography within 3–24 h after thrombolysis. Patients with residual stenosis ≥70% in the infarct-related artery underwent PCI, regardless of flow or patency status. Epicardial arterial flow was assessed using thrombolysis in myocardial infarction (TIMI) flow grade and TIMI frame count (CTFC). Myocardial perfusion was assessed using myocardial blush grade (MBG) and TIMI myocardial perfusion frame count (TMPFC). Forty-nine patients were enrolled and underwent diagnostic angiography 3–11.3 h (median 6.5 h) after thrombolysis. Forty-six patients underwent PCI. No procedure-related complications occurred, except two patients who had no reflow after PCI. Twenty-two (47.8%) patients had TIMI grade 3 flow before PCI and 33 (71.7%) after PCI. CTFC was significantly improved after PCI (48.5 ± 32.1 vs. 37.9 ± 25.6, P = 0.01). MBG and TMPFC exhibited a similar improving trend after PCI, and the best myocardial perfusion tended to be achieved 3–12 h after lysis. During the 30-day follow-up, there were two deaths. The composite end point of death, cardiogenic shock, heart failure, reinfarction, and recurrent ischemia occurred in four patients. TIMI minor bleeding occurred in four patients. No TIMI major bleeding and stroke occurred. Early routine PCI after half-dose alteplase thrombolysis in Chinese population appears feasible. A larger clinical trial should be designed to further elucidate its efficacy and safety. Early PCI after thrombolysis in STEMI: The EARLY-PCI pilot feasibility study, ChiCTR-TNC-11001363.
Keywords
Angioplasty Clinical trial Myocardial infarction ThrombolysisNotes
Acknowledgments
This work was supported by the Program for Outstanding Medical Academic Leader from Shanghai Municipal Health Bureau.
References
- 1.de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K, Kastrati A, Rosengren A, Steg PG, Tubaro M, Verheugt F, Weidinger F, Weis M, ESC Committee for Practice Guidelines (CPG) (2008) Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 29:2909–2945PubMedCrossRefGoogle Scholar
- 2.Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, Hochman JS, Krumholz HM, Lamas GA, Mullany CJ, Pearle DL, Sloan MA, Smith SC Jr; 2004 Writing Committee Members, Anbe DT, Kushner FG, Ornato JP, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW (2008) 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 51:210–247Google Scholar
- 3.Han Y, Jing Q, Xu B, Yang L, Liu H, Shang X, Jiang T, Li Z, Zhang H, Li H, Qiu J, Liu Y, Li Y, Chen X, Gao R, CREATE (Multi-Center Registry of Excel Biodegradable Polymer Drug-Eluting Stents) Investigators (2009) Safety and efficacy of biodegradable polymer-coated sirolimus-eluting stents in “real-world” practice: 18-month clinical and 9-month angiographic outcomes. JACC Cardiovasc Interv 2:303–309PubMedCrossRefGoogle Scholar
- 4.Gibson CM (1999) Primary angioplasty compared with thrombolysis: new issues in the era of glycoprotein IIb/IIIa inhibition and intracoronary stenting. Ann Intern Med 130:841–847PubMedGoogle Scholar
- 5.D’Souza SP, Mamas MA, Fraser DG, Fath-Ordoubadi F (2011) Routine early coronary angioplasty versus ischaemia-guided angioplasty after thrombolysis in acute ST-elevation myocardial infarction: a meta-analysis. Eur Heart J 32:972–982PubMedCrossRefGoogle Scholar
- 6.Kushner FG, Hand M, Smith SC Jr, King SB, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE Jr, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO (2009) 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. Circulation 120:2271–2306PubMedCrossRefGoogle Scholar
- 7.Borgia F, Goodman SG, Halvorsen S, Cantor WJ, Piscione F, May MRL, Fernández-Avilés F, Sánchez PL, Dimopoulos K, Scheller B, Armstrong PW, Mario CD (2010) Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation myocardial infarction: a meta-analysis. Eur Heart J 31:2156–2169PubMedCrossRefGoogle Scholar
- 8.National Institute for Health and Clinical Excellence (NHS) (2009) 2002/054 NICE guidance: guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction. http://www.nice.org.uk/newsroom/pressreleases/pressreleasearchive/pressreleases2002/2002_054_nice_issues_guidance_on_the_use_of_drugs_for_early_thrombolysis_in_the_treatment_of_acute_myocardial_infarction.jsp. Accessed 23 May 2009
- 9.Gibson CM, Cannon CP, Daley WL, Dodge JT, Alexander B, Marble SJ, McCabe CH, Raymond L, Fortin T, Poole WK, Braunwald E (1996) TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 93:879–888PubMedGoogle Scholar
- 10.Gibson CM, Murphy SA, Rizzo MJ, Ryan KA, Marble SJ, McCabe CH, Van de Werf F, Braunwald E (1999) Relationship between TIMI frame count and clinical outcomes after thrombolytic administration. thrombolysis in myocardial infarction (TIMI) study group. Circulation 99:1945–1950PubMedGoogle Scholar
- 11.van’t Hof AW, Liem A, Suryapranata H, Hoorntje JC, de Boer MJ, Zijlstra F (1998) Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction: myocardial blush grade: Zwolle Myocardial Infarction Study Group. Circulation 97:2302–2306Google Scholar
- 12.Song D, Pu J, Qiao ZQ, Shan PR, Song W, Du YP, Shen JY, Jin SX, Sun Y, Shen L, Lim YL, He B (2010) TIMI myocardial perfusion frame count: a new method to assess myocardial perfusion and its predictive value for short-term prognosis. Cath Cardiovasc Interv 75:722–732CrossRefGoogle Scholar
- 13.Bovill EG, Terrin ML, Stump DC, Berke AD, Frederick M, Collen D, Feit F, Gore JM, Hillis LD, Lambrew CT (1991) Hemorrhagic events during therapy with recombinant tissue-type plasminogen activator, heparin, and aspirin for acute myocardial infarction. Results of the thrombolysis in myocardial infarction (TIMI), phase II trial. Ann Intern Med 115:256–265PubMedGoogle Scholar
- 14.Ross AM, Gao RL, Coyne KS, Chen J, Yao K, Yang Y, Qin X, Qiao S, Yao M, Investigators TUCC (2001) A randomized trial confirming the efficacy of reduced dose recombinant tissue plasminogen activator in a Chinese myocardial infarction population and demonstrating superiority to usual dose urokinase: the TUCC trial. Am Heart J 142:244–247PubMedCrossRefGoogle Scholar
- 15.Henry TD, Sharkey SW, Burke MN, Chavez IJ, Graham KJ, Henry CR, Lips DL, Madison JD, Menssen KM, Mooney MR, Newell MC, Pedersen WR, Poulose AK, Traverse JH, Unger BT, Wang YL, Larson DM (2007) A regional system to provide timely access to percutaneous coronary intervention for ST-elevation myocardial infarction. Circulation 116:721–728PubMedCrossRefGoogle Scholar
- 16.Pu J, Shan PR, Ding S, Qiao ZQ, Jiang LS, Song W, YP DU, Shen JY, Shen LH, Jin SX, He B (2011) Factors affecting thrombolysis in myocardial infarction myocardial perfusion frame count: insights of myocardial tissue-level reperfusion from a novel index for assessing myocardial perfusion. Chin Med J (Engl) 124:873–878Google Scholar
- 17.Di Mario C, Dudek D, Piscione F, Di Mario C, Dudek D, Piscione F, Mielecki W, Savonitto S, Murena E, Dimopoulos K, Manari A, Gaspardone A, Ochala A, Zmudka K, Bolognese L, Steg PG, Flather M (2008) 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. Lancet 371:559–568PubMedCrossRefGoogle Scholar
- 18.Cantor WJ, Fitchett D, Borgundvaag B, Ducas J, Heffernan M, Cohen EA, Morrison LJ, Langer A, Dzavik V, Mehta SR, Lazzam C, Schwartz B, Casanova A, TRANSFER-AMI Trial Investigators (2009) Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Engl J Med 360:2705–2718PubMedCrossRefGoogle Scholar