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Reperfusion therapy guidelines

Cheuk-Kit Wong
Current guidelines on STEMI reperfusion management do not incorporate further electrocardiographic details over the presence of significant ST elevation. Fibrinolysis is considered an alternative therapy to primary PCI if there is a long PCI-related delay, but the 2 therapies should not be combined. Meanwhile, reperfusion for ischemic stroke has evolved on mechanistic understanding - reperfusion benefit being greatest in the patient with small "core" infarct and large ischemic "penumbra". Fibrinolysis is not regarded as an alternative to mechanical thrombectomy, and the 2 therapies can be combined...
November 11, 2016: International Journal of Cardiology
Yotsawee Chotechuang, Arintaya Phrommintikul, Roungtiva Muenpa, Jayanton Patumanond, Tuanchai Chaichuen, Srun Kuanprasert, Noparat Thanachikun, Thanawat Benjanuwatra, Apichard Sukonthasarn
BACKGROUND: Fibrinolytic therapy is the main reperfusion therapy for most STEMI patients in several countries. Current practice guidelines recommended routine early pharmacoinvasive (within 3-24 h after successful fibrinolysis, however it cannot be performed in timely fashion due to limitation of PCI-capable hospitals. This study aimed to evaluate the prognostic utility of the GRACE score in patients receiving delayed intervention after successful fibrinolysis in non PCI-capable hospital...
November 8, 2016: BMC Cardiovascular Disorders
Ravi S Hira, Deepak L Bhatt, Gregg C Fonarow, Paul A Heidenreich, Christine Ju, Salim S Virani, Biykem Bozkurt, Laura A Petersen, Adrian F Hernandez, Lee H Schwamm, Zubin J Eapen, Michelle A Albert, Li Liang, Roland A Matsouaka, Eric D Peterson, Hani Jneid
BACKGROUND: Timely reperfusion after ST-elevation myocardial infarction (STEMI) improves survival. Guidelines recommend primary percutaneous coronary intervention (PPCI) within 90 minutes of arrival at a PCI-capable hospital. The alternative is fibrinolysis within 30 minutes for those in those for whom timely transfer to a PCI-capable hospital is not feasible. METHODS AND RESULTS: We identified STEMI patients receiving reperfusion therapy at 229 hospitals participating in the Get With the Guidelines-Coronary Artery Disease (GWTG-CAD) database (January 1, 2003 through December 31, 2008)...
October 6, 2016: Journal of the American Heart Association
YeongHo Choi, Yu Jin Lee, Sang Do Shin, Kyoung Jun Song, KyungWon Lee, Eui Jung Lee, Yu Jin Kim, Ki Ok Ahn, Ki Jeong Hong, Young Sun Ro
BACKGROUND: Timely transfer and percutaneous coronary intervention (PCI) with or without thrombolysis are recommended by the American Heart Association (AHA) to care for ST-segment elevation myocardial infarction (STEMI) patients who present first to a non-PCI-capable hospital. This study was to evaluate the impact on in-hospital mortality of the compliance with guidelines regarding to the time of PCI for patients with STEMI who were transferred to a capable PCI hospital. METHODS: We used the CArdioVAscular disease Surveillance data from November 2007 to December 2012 for this study...
September 16, 2016: American Journal of Emergency Medicine
Evangelos Giannitsis, Hugo A Katus
BACKGROUND: Pulmonary embolism (PE) is associated with high all-cause and PE-related mortality and requires individualized management. After confirmation of PE, a refined risk stratification is particularly warranted among normotensive patients. Previous prognostic models favored combinations of echocardiography or computed tomography suggestive of right ventricular (RV) dysfunction together with biomarkers of RV dysfunction (natriuretic peptides) or myocardial injury (cardiac troponins) to identify candidates for thrombolysis or embolectomy...
October 19, 2016: Clinical Chemistry
Amrou Sarraj, Navdeep Sangha, Muhammad Shazam Hussain, Dolora Wisco, Nirav Vora, Lucas Elijovich, Nitin Goyal, Michael Abraham, Manoj Mittal, Lei Feng, Abel Wu, Vallabh Janardhan, Suman Nalluri, Albert J Yoo, Megan George, Randall Edgell, Rutvij J Shah, Clark Sitton, Emilio Supsupin, Suhas Bajgur, M Carter Denny, Peng R Chen, Mark Dannenbaum, Sheryl Martin-Schild, Sean I Savitz, Rishi Gupta
Importance: Randomized clinical trials have shown the superiority of endovascular therapy (EVT) compared with best medical management for acute ischemic strokes with large vessel occlusion (LVO) in the anterior circulation. However, of 1287 patients enrolled in 5 trials, 94 with isolated second (M2) segment occlusions were randomized and 51 of these received EVT, thereby limiting evidence for treating isolated M2 segment occlusions as reflected in American Heart Association guidelines...
September 12, 2016: JAMA Neurology
T Viergutz, J Grüttner, T Walter, C Weiss, B Haaff, G Pollach, C Madler, T Luiz
BACKGROUND: In the current guidelines for the treatment of patients with ST-segment elevation myocardial infarction (STEMI), the European Society of Cardiology (ESC) recommends preclinical fibrinolysis as a reperfusion therapy if, due to long transportation times, no cardiac catheterisation is available within 90-120 min. However, there is little remaining in-depth expertise in this method because fibrinolysis is presently only rarely indicated. METHODS: In a rural area in southwestern Germany, where an emergency primary percutaneous coronary intervention was not routinely available within 90-120 min, 156 STEMI patients underwent fibrinolysis with the plasminogen activator reteplase, performed by trained emergency physicians...
September 2016: Der Anaesthesist
Robert W Harrison, DaJuanicia Simon, Amy L Miller, James A de Lemos, Eric D Peterson, Tracy Y Wang
BACKGROUND: Adherence to guideline-based therapy improves patient outcomes after acute myocardial infarction (AMI) and hospital AMI volume is associated with reperfusion care, but the extent hospital AMI volume is associated with overall guideline adherence is unclear. METHODS AND RESULTS: We studied 486 hospitals treating 249,877 AMI patients in ACTION Registry-GWTG from January 1, 2007, to March 31, 2011. Hospital adherence to each American College of Cardiology/American Heart Association performance measure was compared between tertiles defined by hospital AMI volume: low (≤108 cases/y), middle (≥109 and ≤227 cases/y), and high (≥228 cases/y)...
August 2016: American Heart Journal
Anna Sina P Meyer, Sisse R Ostrowski, Jesper Kjaergaard, Pär I Johansson, Christian Hassager
BACKGROUND: Morbidity and mortality following initial survival of cardiac arrest remain high despite great efforts to improve resuscitation techniques and post-resuscitation care, in part due to the ischemia-reperfusion injury secondary to the restoration of the blood circulation. Patients resuscitated from cardiac arrest display evidence of endothelial injury and coagulopathy (hypocoagulability, hyperfibrinolysis), which in associated with poor outcome. Recent randomized controlled trials have revealed that treatment with infusion of prostacyclin reduces endothelial damage after major surgery and AMI...
2016: Trials
Derek P Chew, Ian A Scott, Louise Cullen, John K French, Tom G Briffa, Philip A Tideman, Stephen Woodruffe, Alistair Kerr, Maree Branagan, Philip Eg Aylward
INTRODUCTION: The modern care of suspected and confirmed acute coronary syndrome (ACS) is informed by an extensive and evolving evidence base. This clinical practice guideline focuses on key components of management associated with improved clinical outcomes for patients with chest pain or ACS. These are presented as recommendations that have been graded on both the strength of evidence and the likely absolute benefit versus harm. Additional considerations influencing the delivery of specific therapies and management strategies are presented as practice points...
August 1, 2016: Medical Journal of Australia
Padmaa Venkatason, Yong Z Zubairi, Imran Hafidz, Wan Azman Wan, Ahmad S Zuhdi
BACKGROUND: The administration of evidence-based pharmacotherapy and timely primary percutaneous coronary intervention have been shown to improve outcome in ST elevation myocardial infarction (STEMI). However, implementation remains a challenge due to the limitations in facilities, expertise and funding. OBJECTIVES: To investigate adherence to guideline-based management and mortality of STEMI patients in Malaysia. DESIGN: Retrospective analysis...
May 2016: Annals of Saudi Medicine
Yacov Shacham, Shafik Khoury, Nir Flint, Arie Steinvil, Ben Sadeh, Yaron Arbel, Yan Topilsky, Gad Keren
BACKGROUND: Acute myocardial infarction and remodeling of the left ventricle is associated with significant changes in systolic and diastolic echocardiographic derived indices. The investigators have tried to determine whether persistence of increased ratio of transmitral flow velocity (E) to early mitral annulus velocity (e'), signifying increased cardiac filling pressure, is associated with left ventricular (LV) remodeling and increased chamber size among patients presenting with ST-segment elevation myocardial infarction, who underwent successful reperfusion with primary percutaneous coronary intervention...
August 2016: Journal of the American Society of Echocardiography
Emily M Bucholz, Neel M Butala, Sharon-Lise T Normand, Yun Wang, Harlan M Krumholz
BACKGROUND: Guideline-based admission therapies for acute myocardial infarction (AMI) significantly improve 30-day survival, but little is known about their association with long-term outcomes. OBJECTIVES: This study evaluated the association of 5 AMI admission therapies (aspirin, beta-blockers, acute reperfusion therapy, door-to-balloon [D2B] time ≤90 min, and time to fibrinolysis ≤30 min) with life expectancy and years of life saved after AMI. METHODS: We analyzed data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries hospitalized for AMI, with 17 years of follow-up...
May 24, 2016: Journal of the American College of Cardiology
Céline Rousseaux, Pierre Mols, Peter R Sinnaeve, Carl Convens, Philippe Dubois, Pascal Vranckx, Sofie Gevaert, Patrick Coussement, Ahmed Se Ramadan, Christophe Beauloye, Marc Renard, Patrick Evrard, Jean-François Argacha, Herbert De Raedt, Kristien Wouters, Marc J Claeys
OBJECTIVES: Emergency medical services play a key role in the recognition and treatment of ST-segment elevation myocardial infarction (STEMI). This study evaluates the effect of emergency medical services use on adherence to reperfusion therapy guidelines in Belgian STEMI patients and on in-hospital mortality. METHODS: The mode of admission with against without emergency medical services was associated with baseline risk profile, reperfusion modalities and in-hospital mortality in 5692 consecutive STEMI patients from 2012 to 2014...
September 2016: European Heart Journal. Acute Cardiovascular Care
J Li, X Li, S Hu, Y Yu, X F Yan, L X Jiang
OBJECTIVE: To assess trends in clinical characteristics, treatments, and outcomes for hospitalized patients with ST-segment elevation myocardial infarction(STEMI) in eastern urban China from 2001 to 2011. METHODS: The data were obtained from the China PEACE-retrospective acute myocardial infarction study. Patients admitted to hospital in the eastern urban China for STEMI were selected via two-stage random sampling. The first phase was to identify participating hospitals via a simple random-sampling procedure...
April 24, 2016: Zhonghua Xin Xue Guan Bing za Zhi
V V Kuz'kov, E V Fot, A A Smjotkin, K M Lebedinskij, M Yu Kirov
Current guidelines suggest that an early and aggressive fluid therapy is the best rescue approach to restore and preserve cardiac index, organ function and decrease the risk of multiple organ failure in shock of various origin. However, escala- tion of fluid resuscitation is a double-edged sword often associated with reperfusion, glicocalyx injury, capillary leakage, delayed weight gain and heperhydration. The body of evidences demons trates that an excessive fluid load in ICUpatient with global increased permeability syndrome, and, particularly, in ARDS and acute kidney injury can be devastating, particularly when guided with central venous pressure...
November 2015: Anesteziologiia i Reanimatologiia
Maurice Kakou-Guikahue, Roland N'Guetta, Jean-Baptiste Anzouan-Kacou, Euloge Kramoh, Raymond N'Dori, Serigne Abdou Ba, Maboury Diao, Moustapha Sarr, Abdoul Kane, Adama Kane, Findide Damorou, Dadhi Balde, Mamadou Bocary Diarra, Mohamed Djiddou, Gisèle Kimbally-Kaki, Patrice Zabsonre, Ibrahim Ali Toure, Martin Houénassi, Habib Gamra, Bachir Chajai, Benoit Gerardin, Rémy Pillière, Pierre Aubry, Marie-Christine Iliou, Richard Isnard, Pascal Leprince, Yves Cottin, Edmond Bertrand, Yves Juillière, Jean-Jacques Monsuez
BACKGROUND: Whereas the coronary artery disease death rate has declined in high-income countries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa, where their management remains a challenge. AIM: To propose a consensus statement to optimize management of ACS in sub-Saharan Africa on the basis of realistic considerations. METHODS: The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing features of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, Ivory Coast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategies and policies may be expected using readily available healthcare facilities...
June 2016: Archives of Cardiovascular Diseases
G Ciliberti, M Del Pinto, F Notaristefano, G Zingarini, G Ambrosio, C Cavallini
Identification of acute myocardial infarction (AMI) in the presence of left bundle branch block (LBBB) remains challenging. European guidelines recommend prompt reperfusion therapy in patients with suspected ongoing myocardial ischemia and new or presumably new LBBB, whereas AHA/ACC guidelines state that LBBB should not be considered diagnostic of AMI in isolation. Sgarbossa criteria and their recent modified version with the introduction of ST/S ratio can be helpful in this setting. A clinical-instrumental algorithm to manage suspected AMI in the presence of LBBB has been recently proposed...
July 2016: Journal of Electrocardiology
Jaime Masjuán, José Álvarez-Sabín, Susana Arias-Rivas, Miguel Blanco, Alicia de Felipe, Irene Escudero-Martínez, Blanca Fuentes, Jaime Gállego-Culleré, Francisco Moniche-Álvarez, Lucía Muñoz, Natalia Pérez de la Ossa-Herrero, Patricia Sahuquillo, Estevo Santamarina, Borja Sanz, José I Tembl, Beatriz Zandio
INTRODUCTION: A stroke is a time-dependent medical emergency. Swiftness in its recognition and in the care received by the patients plays a key role in the prognosis. AIMS: To analyse the medical intervention times, to evaluate possible areas where improvements can be made and to examine the allocation of resources in the centres. PATIENTS AND METHODS: The study was based on a prospective register of patients with suspected stroke and stroke code activation treated in eight experienced Spanish stroke units...
April 1, 2016: Revista de Neurologia
Eleanor R Joy, John Kurian, Chris P Gale
AIM: To compare the effectiveness of primary percutaneous coronary intervention (pPCI) and fibrinolytic therapy (FL) for the acute management of ST elevation myocardial infarction (STEMI). METHODS: A review of guidelines and PubMed literature comparing clinical outcomes of patients with STEMI treated with pPCI or FL. RESULTS: Earlier trials reported reduced mortality and reinfarction with pPCI. Recent randomized data suggest similar outcomes for delayed pPCI compared with FL, especially in geographically remote areas...
March 2016: Journal of Comparative Effectiveness Research
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