Skip to main content
SpringerLink
Log in

Angioplasty within 24 h after thrombolysis in patients with acute ST-elevation myocardial infarction: current use, predictors and outcome

Results of the MITRA plus registry

  • ORIGINAL PAPER
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

Percutaneous coronary intervention (PCI) early after thrombolysis (early PCI) in patients with ST-elevation myocardial infarction (STEMI) is currently advised by clinical guidelines, but little is known about its use in clinical practice.

Methods

We analysed the MITRA (Maximal Individual Therapy of Acute Myocardial Infarction) plus registry.

Results

Out of a total of 34276 patients with STEMI, 10600 (30.9%) were treated with intravenous thrombolysis. Out of these patients, 487 (4.6%) patients received an angioplasty between 61 min and 24 hours after thrombolysis. They were compared to 10113 (95.4%) patients who received PCI either later than 24 hours after thrombolysis or not at all. A continuous increase in the frequency of early PCI between the years 1994 (2%)-2002 (16.7%) was observed. After adjusting for confounding variables independent predictors to use early PCI were the increasing year of inclusion, the facility of the hospital to perform PCI, younger age and male gender. Hospital mortality was 7.2% in patients receiving early PCI, compared to 11.2% in the other group (<0.01). Independent predictors for a higher hospital mortality were shock, age >65 years, female gender, an anterior STEMI and a prehospital delay of >3 hours. However, early PCI was not longer associated with a lower mortality (OR 0.95, 95% CI 0.64–1.14).

Conclusion

Early PCI after thrombolysis is used infrequently in current clinical practice in Germany. Especially ‘low risk’ patients were treated with an early PCI, which may contribute to the missing effect on mortality compared to no or late PCI after thrombolysis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

ACE:

Angiotensin-converting enzyme

ACEI:

Angiotensin-converting enzyme inhibitor

AMI:

Acute myocardial infarction

ASSENT:

Assessment of the safety and efficacy of a new treatment strategy

CAPITAL AMI study:

Combined angioplasty and pharmacological intervention versus thrombolysis alone in acute myocardial infarction

CAPTIM:

Comparison of angioplasty and prehospital thrombolysis in acute myocardial infarction

CARESS in AMI:

Combined Abciximab RE-teplase Stent Study in Acute Myocardial Infarction

CI:

Confidence interval

GRACIA:

Grupo de Análisis de la Cardiopatía Isquémica Aguda

DANAMI:

Danish trial in acute myocardial infarction

MIP:

Myocardial infarction project

MITRA:

Maximal individual therapy of acute myocardial infarction

MIR:

Myocardial infarction registry

OR:

Odds ratio

PCI:

Percutaneous coronary intervention

SIAM III:

Southwest German Interventional Study in Acute Myocardial Infarction

STEMI:

ST-elevation myocardial infarction

References

  1. Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KA, Julian D, Lengyel M, Neumann FJ, Ruzyllo W, Thygesen C, Underwood SR, Vahanian A, Verheugt FW, Wijns W, Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology (2003) Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 24:28–66

    Article  PubMed  Google 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: developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation 117:296–329

    Article  PubMed  Google Scholar 

  3. Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 36:13–20

    Article  Google Scholar 

  4. Andersen HR, Nielsen TT, Rasmussen K, Thuesen L, Kelbaek H, Thayssen P, Abildgaard U, Pedersen F, Madsen JK, Grande P, Villadsen AB, Krusell LR, Haghfelt T, Lomholt P, Husted SE, Vigholt E, Kjaergard HK, Mortensen LS; DANAMI-2 Investigators (2003) A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med 349:733–742

    Article  PubMed  Google Scholar 

  5. Rustige J, Schiele R, Burczyk U, Koch A, Gottwik M, Neuhauss KL, Tebbe U, Uebis R, Senges J (1997) The 60 minutes Myocardial Infarction Project. Treatment and clinical outcome of patients with acute myocardial infarction in Germany. Eur Heart J 18:1438–1446

    PubMed  CAS  Google Scholar 

  6. Schuster S, Koch A, Burczyk U, Schiele R, Glunz HG, Voigtlander T, Limbourg P, Stuby K, Berg G, Gieseler U, Jakob M, Hauptmann P, Senges J (1999) Use of coronary angiography after acute myocardial infarction in Germany: a comparison of daily clinical practice with international guidelines. MITRA Study. Z Kardiol 88:795–801

    Article  PubMed  CAS  Google Scholar 

  7. Wagner S, Schneider S, Schiele R, Fischer F, Dehn H, Grube R, Becker G, Baumgartel B, Altmann E, Senges J (1999) Acute myocardial infarction in Germany between 1996 and 1998: therapy and intrahospital course. Results of the Myocardial Infarction Registry (MIR) in Germany. Z Kardiol 88:857–867

    Article  PubMed  CAS  Google Scholar 

  8. Gitt AK, Schiele R, Meisner F, Wienbergen H, Heer T, Gottwik M, Senges J, Schneider S (2001) Myocardial infarction redefined: implication of the new definition of non-ST-segment elevation myocardial infarction on clinical practice: results of the ACOS registry. Eur Heart J 22:3276

    Google Scholar 

  9. Silber S, Albertsson P, Aviles FF, Camici PG, Colombo A, Hamm C, Jorgensen E, Marco J, Nordrehaug JE, Ruzyllo W, Urban P, Stone GW, Wijns W (2005) Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology. Eur Heart J 26:804–847

    Article  PubMed  Google Scholar 

  10. Fernandez-Aviles F, Alonso JJ, Castro-Beiras A, Vazquez N, Blanco J, Alonso-Briales J, Lopez-Mesa J, Fernandez-Vazquez F, Calvo I, Martinez-Elbal L, San Roman JA, Ramos B (2004) Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA–1): a randomised controlled trial. Lancet 364:1045–1053

    Article  PubMed  Google Scholar 

  11. Le May MR, Wells GA, Labinaz M, Davies RF, Turek M, Leddy D, Maloney J, McKibbin T, Quinn B, Beanlands RS, Glover C, Marquis JF, O’Brien ER, Williams WL, Higginson LA (2005) Combined angioplasty and pharmacological intervention versus thrombolysis alone in acute myocardial infarction (CAPITAL AMI study). J Am Coll Cardiol 46:417–424

    Article  PubMed  Google Scholar 

  12. Scheller B, Hennen B, Hammer B, Walle J, Hofer C, Hilpert V, Winter H, Nickenig G, Bohm M, SIAM III Study Group (2003) Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction. J Am Coll Cardiol 42:634–641

    Article  PubMed  Google Scholar 

  13. Collet JP, Montalescot G, Le MM, Borentain M, Gershlick A (2006) Percutaneous coronary intervention after fibrinolysis: a multiple meta-analyses approach according to the type of strategy. J Am Coll Cardiol 48:1326–1335

    Article  PubMed  Google Scholar 

  14. 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; CARESS-in-AMI (Combined Abciximab RE-teplase Stent Study in Acute Myocardial Infarction) Investigators (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 371:559–568

    Article  PubMed  CAS  Google Scholar 

  15. Kindermann M, Adam O, Werner N, Böhm M (2007) Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007: (FINESSE, CARESS, OASIS 5, PRAGUE-8, OPTIMIST, GRACE, STEEPLE, SCAAR, STRATEGY, DANAMI-2, ExTRACT-TIMI-25, ISAR-REACT 2, ACUITY, ALOFT, 3CPO, PROSPECT, EVEREST, COACH, BENEFiT, MERLIN-TIMI 36, SEARCH-MI, ADVANCE, WENBIT, EUROASPIRE I-III, ARISE, getABI, RIO). Clin Res Cardiol 96(11):767–786

    Article  PubMed  Google Scholar 

  16. McClelland AJJ, Owens CG, Walsh SJ, McCarty D, Mathew T, Stevenson M, Gracey H, Khan MM, Adgey JAA (2005) Percutaneous coronary intervention and 1 year survival in patients treated with fibrinolytic therapy for acute ST-elevation myocardial infarction. Eur Heart J 26:544–548

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen am Rhein, Germany

    Oliver Koeth, Timm Bauer, Harm Wienbergen, Anselm Kai Gitt, Claus Juenger, Uwe Zeymer, Jochen Senges & Ralf Zahn

  2. Department of Cardiology, Krankenhaus der Barmherzigen Brüder, Trier, Germany

    Karl Eugen Hauptmann

  3. Department of Cardiology, Klinikum Westpfalz, Kaiserslautern, Germany

    Hans Georg Glunz

  4. Department of Cardiology, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany

    Udo Sechtem

Authors
  1. Oliver Koeth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timm Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harm Wienbergen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anselm Kai Gitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Claus Juenger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Uwe Zeymer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karl Eugen Hauptmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hans Georg Glunz
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Udo Sechtem
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jochen Senges
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ralf Zahn
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Maximal Individual Therapy in Acute Myocardial Infarction Plus (MITRA Plus) Study Group

Corresponding author

Correspondence to Oliver Koeth.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koeth, O., Bauer, T., Wienbergen, H. et al. Angioplasty within 24 h after thrombolysis in patients with acute ST-elevation myocardial infarction: current use, predictors and outcome. Clin Res Cardiol 98, 107–113 (2009). https://doi.org/10.1007/s00392-008-0730-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-008-0730-1

Keywords

Search

Navigation