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Leonardo de F C Guimarães, Philippe Généreux, Diego Silveira, Antonio Eduardo Pesaro, Felipe Falcão, Bruno Robalinho C Barbosa, Cristiano Freitas de Souza, Francisco A H Fonseca, Cláudia Maria Rodrigues Alves, Antônio Carlos de Camargo Carvalho, Gregg W Stone, Adriano Caixeta
BACKGROUND: A pharmacodynamic comparison between ticagrelor and prasugrel after fibrinolytic therapy has not yet been performed. METHODS: In the single-center SAMPA trial, 50 consecutive STEMI patients previously treated with clopidogrel and undergoing a pharmacoinvasive strategy were randomized to either a ticagrelor (n=25) 180mg loading dose followed by 90mg bid, or a prasugrel (n=25) 60mg loading dose followed by 10mg/day, initiated after fibrinolytic therapy but before angiography...
March 1, 2017: 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
Xi Li, Jing Li, Frederick A Masoudi, John A Spertus, Zhenqiu Lin, Harlan M Krumholz, Lixin Jiang
OBJECTIVES: As the predominant approach to acute reperfusion for ST segment elevation myocardial infarction (STEMI) in many countries, fibrinolytic therapy provides a relative risk reduction for death of ∼16% across the range of baseline risk. For patients with low baseline mortality risk, fibrinolytic therapy may therefore provide little benefit, which may be offset by the risk of major bleeding. We aimed to construct a tool to determine if it is possible to identify a low-risk group among fibrinolytic therapy-eligible patients...
October 24, 2016: BMJ Open
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
Vikas Agrawal, Balaji V Lohiya, Bhupendra K Sihag, Rajpal Prajapati
INTRODUCTION: Despite cardiovascular diseases having grown to epidemic proportions, there are few studies from India pertaining to Acute Coronary Syndrome (ACS), more so from the region of Purvanchal which is less developed with more poverty. Our study is first of its kind in this region of patients presenting for the first time with ACS. AIM: The present study was undertaken to study the clinical and angiographic characteristics of ACS patients of Purvanchal. MATERIALS AND METHODS: This was a prospective cohort study of 100 patients admitted with ACS...
September 2016: Journal of Clinical and Diagnostic Research: JCDR
Surya Dharma, Hananto Andriantoro, Ismi Purnawan, Iwan Dakota, Faris Basalamah, Beny Hartono, Ronaly Rasmin, Herawati Isnanijah, Muhammad Yamin, Ika Prasetya Wijaya, Vireza Pratama, Tjatur Bagus Gunarto, Yahya Berkahanto Juwana, Frits R W Suling, A M Onny Witjaksono, Hengkie F Lasanudin, Kurniawan Iskandarsyah, Hardja Priatna, Pradana Tedjasukmana, Uki Wahyumandradi, Adrianus Kosasih, Imelda A Budhiarti, Wisnoe Pribadi, Jeffrey Wirianta, Utojo Lubiantoro, Rini Pramesti, Diah Retno Widowati, Sissy Kartini Aminda, M Abas Basalamah, Sunil V Rao
OBJECTIVE: We studied the characteristics of patients with ST segment elevation myocardial infarction (STEMI) after expansion of a STEMI registry as part of the STEMI network programme in a metropolitan city and the surrounding area covering ∼26 million inhabitants. DESIGN: Retrospective cohort study. SETTING: Emergency department of 56 health centres. PARTICIPANTS: 3015 patients with acute coronary syndrome, of which 1024 patients had STEMI...
August 31, 2016: BMJ Open
Cátia Costa, David Durão, Adriana Belo, Kevin Domingues, Beatriz Santos, Margarida Leal
INTRODUCTION: Percutaneous coronary intervention (PCI) is currently considered the gold-standard treatment of acute coronary syndromes with ST-segment elevation (STEMI). However, this is not the reality of many European centers, where thrombolysis is performed as primary therapy. AIMS: To determine, in a STEMI population that performed successful fibrinolytic treatment, if the performance of coronary angiography after the first 24h was associated with more hospital complications, including higher mortality, compared with its performance in the recommended time...
November 1, 2016: International Journal of Cardiology
Pravesh Kumar Bundhun, Girish Janoo, Meng-Hua Chen
From the year 1986 onwards, several studies have been published focusing on the comparison between fibrinolysis and primary percutaneous coronary intervention (PPCI) in patients with ST segment elevated myocardial infarction (STEMI). However, because antiplatelet and anticoagulating medications are used in approximation, before and during these procedures, bleeding events have been reported to be associated with both reperfusion therapies. This study aimed to compare the bleeding events associated with fibrinolytic therapy and primary angioplasty in patients with STEMI...
June 2016: Medicine (Baltimore)
Amirreza Solhpour, Kay-Won Chang, Salman A Arain, Prakash Balan, Yelin Zhao, Catalin Loghin, James J McCarthy, H Vernon Anderson, Richard W Smalling
OBJECTIVES: We investigated whether prehospital, reduced dose fibrinolysis coupled with urgent percutaneous coronary intervention (FAST-PCI) reduces mortality and cardiac magnetic resonance (CMR) measures of infarct size, compared with primary percutaneous coronary intervention (PPCI), in patients with ST-elevation myocardial infarction (STEMI). BACKGROUND: Current standard therapy for STEMI is PPCI. However, FAST-PCI may shorten ischemic time (IT) and improve outcomes...
November 2016: Catheterization and Cardiovascular Interventions
R N'Guetta, H Yao, A Ekou, M P N'Cho-Mottoh, I Angoran, M Tano, C Konin, I Coulibaly, J B Anzouan-Kacou, R Seka, A M Adoh
AIM: To assess prevalence, characteristics and management of acute coronary syndromes in sub-Saharan Africa population. PATIENTS AND METHODS: Prospective survey from January, 2010 to December, 2013, carried out among patients aged 18 years old, admitted to intensive care unit of Abidjan Heart Institute for acute coronary syndrome (ACS). RESULTS: Four hundred and twenty-five (425) patients were enrolled in this study. Prevalence of ACS was 13...
April 2016: Annales de Cardiologie et D'angéiologie
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
Peter R Sinnaeve, Thierry Danays, Kris Bogaerts, Frans Van de Werf, Paul W Armstrong
Elderly patients constitute a large and growing proportion of ST-elevation myocardial infarction (STEMI) patients, yet they have been under-represented or even excluded from reperfusion trials. Despite evidence that fibrinolysis improves outcomes irrespective of age, many elderly STEMI patients still remain undertreated or subject to major delays to primary percutaneous coronary intervention (PCI). The fear of an excessive risk of intracranial hemorrhage (ICH) in these patients can lead to avoidance of potentially life-saving reperfusion treatment, despite the fact that current STEMI guidelines do not exclude the elderly from a pharmaco-invasive strategy...
February 2016: Drugs & Aging
Ruchika Meel, Ricardo Gonçalves
BACKGROUND: Fibrinolytic therapy is a time-critical intervention proven to reduce mortality and morbidity in patients with ST-elevation myocardial infarction (STEMI). Limited data exist in South Africa (SA) regarding time to fibrinolytic therapy for STEMI patients and reasons for delayed therapy. OBJECTIVES: To establish the proportion of STEMI patients receiving fibrinolytic agents at Steve Biko Academic Hospital (SBAH), Pretoria, SA, identify any delays to receiving fibrinolytic agents, and uncover reasons for those delays...
January 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Nish Patel, Nileshkumar J Patel, Badal Thakkar, Vikas Singh, Shilpkumar Arora, Nilay Patel, Chirag Savani, Abhishek Deshmukh, Udho Thadani, Apurva O Badheka, Carlos Alfonso, Gregg C Fonarow, Mauricio G Cohen
Fibrinolytic therapy is still used in patients with ST-segment elevation myocardial infarction (STEMI) when the primary percutaneous coronary intervention cannot be provided in a timely fashion. Management strategies and outcomes in transferred fibrinolytic-treated STEMI patients have not been well assessed in real-world settings. Using the Nationwide Inpatient Sample from 2008 to 2012, we identified 18 814 patients with STEMI who received fibrinolytic therapy and were transferred to a different facility within 24 hours...
January 2016: Clinical Cardiology
Edward L Callachan, Alawi A Alsheikh-Ali, Stevan Bruijns, Lee A Wallis
INTRODUCTION: Physician perceptions about emergency medical services (EMS) are important determinants of improving pre-hospital care for cardiac emergencies. No data exist on physician attitudes towards EMS care of patients with ST-Elevation Myocardial Infarction (STEMI) in the Emirate of Abu Dhabi. OBJECTIVES: To describe the perceptions towards EMS among physicians caring for patients with STEMI in Abu Dhabi. METHODS: We surveyed a convenience sample of physicians involved in the care of patients with STEMI (emergency medicine, cardiology, cardiothoracic surgery and intensive care) in four government facilities with 24/7 Primary PCI in the Emirate of Abu Dhabi...
January 2016: Journal of the Saudi Heart Association
Mitul B Kadakia, Sunil V Rao, Lisa McCoy, Paramita S Choudhuri, Matthew W Sherwood, Scott Lilly, Taisei Kobayashi, Daniel M Kolansky, Robert L Wilensky, Robert W Yeh, Jay Giri
OBJECTIVES: The purpose of this study was to assess usage patterns of transradial access in rescue percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) and associations between vascular access site choice and outcomes. BACKGROUND: Transradial access reduces bleeding and mortality in STEMI patients undergoing primary PCI. Little is known about access site choice and outcomes in patients undergoing rescue PCI after receiving full-dose fibrinolytic therapy for STEMI...
December 21, 2015: JACC. Cardiovascular Interventions
Mohamed Ismail, Wail Nammas
BACKGROUND: Low-dose dobutamine stress echocardiography is increasingly used for identifying myocardial viability. AIM: We explored whether dobutamine-induced strain (S) and strain rate (SR) can identify myocardial viability following fibrinolytic therapy for ST-segment-elevation myocardial infarction (STEMI), taking (99m)Tc-sestamibi scintigraphy as the "gold standard" for diagnosis. METHODS: We enrolled 60 consecutive patients presenting for myocardial viability assessment at least 4 weeks following STEMI...
2015: Frontiers in Cardiovascular Medicine
Arjuna Medagama, Ruwanthi Bandara, Chinthani De Silva, Manoj Prasanna Galgomuwa
BACKGROUND: There are limited contemporary data on the presentation, management and outcomes of acute coronary syndromes (ACS) in Sri Lanka. We aimed to identify the critical issues that limit optimal management of ACS in Sri Lanka. METHODS: We performed a prospectively observational study of 256 consecutive patients who presented with ACS between November 2011 and May 2012 at a tertiary care general medical unit in Sri Lanka. RESULTS: We evaluated data on presentation, management, in-hospital mortality, and major adverse cardiovascular events (MACE) of participants...
2015: BMC Cardiovascular Disorders
Brian Veauthier, Karlynn Sievers, Jaime Hornecker
The first step in inpatient management of acute coronary syndrome (ACS) is determining whether the patient has ST-segment elevation myocardial infarction (STEMI). For STEMI, the initial approach to management is cardiac catheterization with percutaneous coronary intervention (PCI) to reperfuse the blocked artery; PCI should take place within 120 minutes of first medical contact. However, if no contraindications are present, fibrinolytic therapy is preferred if PCI will take more than 120 minutes. In ACS without STEMI, cardiac catheterization with PCI is the recommended approach for patients who are unstable, and for stable patients with high risk assessment scores, diabetes or renal insufficiency, stent placement within the past 6 months, or prior bypass surgery...
October 2015: FP Essentials
Brian Veauthier, Karlynn Sievers, Jaime Hornecker
Patients with chest pain who present to emergency departments have a significantly higher incidence of acute coronary syndrome (ACS) than patients with chest pain presenting to outpatient settings, so emergency department clinicians should have a lower threshold for considering ACS as an etiology. Evaluating patients with suspected ACS in the emergency department involves obtaining a history, physical examination, electrocardiograms (ECGs), and cardiac troponin measurements in conjunction with risk calculators...
October 2015: FP Essentials
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