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Pharmaco-invasive strategy

Marc Jobert, Frederick J Wilson
Pharmaco-electroencephalography (EEG) is a non-invasive method used to assess the effects of pharmacological compounds on the central nervous system by processing the EEG signals which directly reveal the spontaneous synchronised postsynaptic neuronal activity of the cortex with high temporal resolution. The International Pharmaco-Encephalography Society (IPEG) has recently published guidelines, which were produced by a global panel of EEG experts, with the goal to increase the standardisation of pharmaco-EEG studies in human subjects and facilitate the comparability of data across laboratories, thus enabling data-pooling and meta-analyses...
2015: Neuropsychobiology
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
F Addad, J Gouider, E Boughzela, S Kamoun, R Boujenah, H Haouala, H Gamra, F Maatouk, A Ben Khalfallah, S Kachboura, H Baccar, N Ben Halima, A Guesmi, K Sayahi, W Sdiri, A Neji, A Bouakez, K Battikh, R Chettaoui, S Mourali
UNLABELLED: FAST-MI Tunisian registry was initiated by the Tunisian Society of Cardiology and Cardio-vascular Surgery to assess characteristics, management, and hospital outcomes in patients with ST-elevation myocardial infarction (STEMI). METHODS: We prospectively collected data from 203 consecutive patients (mean age 60.3 years, 79.8 % male) with STEMI who were treated in 15 public hospitals (representing 68.2 % of Tunisian public centres treating STEMI patients) during a 3-month period at the end of 2014...
December 2015: Annales de Cardiologie et D'angéiologie
J Hernández-García, J J Giménez-Ruiz, J M Dueñas-Jurado
INTRODUCTION: The aim is to evaluate the outcomes obtained from the implementation of a pre-hospital thrombolysis protocol in 3 rural emergency care teams, as well as delays and strategies of reperfusion applied in the treatment of the ST-segment elevation myocardial infarction. MATERIAL AND METHODS: Retrospective cohort study (n=52) with historical control (n=20) of the patients assisted for ST-segment elevation myocardial infarction. Medical emergency care teams, hospital, computerized medical history and ARIAM register reports were revised, obtaining epidemiological and clinical features, off-hospital management, reperfusion, time intervals and mortality...
October 2016: Semergen
Etienne Puymirat, Julia Caudron, Philippe G Steg, Gilles Lemesle, Yves Cottin, Pierre Coste, François Schiele, Axel de Labriolle, Vincent Bataille, Jean Ferrières, Tabassome Simon, Nicolas Danchin
AIMS: Current guidelines recommend short time delays from qualifying ECG to reperfusion therapy in ST-elevation myocardial infarction (STEMI) patients. Recently, however, it has been suggested that shortening door-to-balloon times might not result in lower mortality, thereby questioning the relevance of current guidelines. The aim of this study was to assess in-hospital and one-year mortality in patients with fibrinolysis or primary percutaneous coronary intervention (PPCI) according to guidelines-recommended times to reperfusion therapy...
October 8, 2015: European Heart Journal. Acute Cardiovascular Care
Roberto Arriaga-Nava, Jesús-Salvador Valencia-Sánchez, Martin Rosas-Peralta, Martin Garrido-Garduño, Moisés Calderón-Abbo
OBJECTIVE: To review the existing evidence on the role of prehospital thrombolysis in patients with ST-segment elevation acute myocardial infarction (STEMI) as part of a strategy of cutting edge to reduce the time of coronary reperfusion and as a consequence improves both the survival and function. METHODS: We used the technique of exploration-reduction-evaluation-analysis and synthesis of related studies, with an overview of current recommendations, data from controlled clinical trials and from the national and international registries about the different strategies for STEMI reperfusion...
October 2015: Archivos de Cardiología de México
Anne Bethke, Sigrun Halvorsen, Ellen Bøhmer, Michael Abdelnoor, Harald Arnesen, Pavel Hoffmann
AIMS: Primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) usually restores TIMI 3 flow in the occluded artery, but microvascular impairment may persist in >30% of patients. Less is known about microvascular reperfusion in STEMI patients treated with thrombolysis followed by early PCI. We aimed to assess the association between TIMI myocardial perfusion (TMP) at the end of the PCI procedure and left ventricular function (LVEF) and infarct size after three months in such patients...
September 2015: EuroIntervention
J J Dalal, T Alexander, P S Banerjee, V Dayasagar, S S lyengar, P G Kerkar, A Mullasari, S P Sathe, G S Wander
UNLABELLED: In India, the prevalence of ST elevation myocardial infarction (STEMI) is rising exponentially leading to cardiovascular morbidity and mortality. Despite advancement in reperfusion therapy (pharmacologic and interventional), the overall utilization, system of care and timely reperfusion remains suboptimal. JUSTIFICATION AND PURPOSE: Alarming treatment delays exist in patients presenting with chest pain observed in real-world and published evidences. Time to diagnose STEMI and initiation of reperfusion therapy at various first medical contacts in India is variable mandating immediate attention...
June 2014: Journal of the Association of Physicians of India
Ali Ahmadi, Hamid Soori, Homeira Sajjadi
This study was conducted to compare the characteristics of patients, with and without diabetes mellitus, presenting with myocardial infarction (MI) and treated with coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or thrombolytic therapy. Factors related to mortality due to MI in Iran were also determined. This study was a prospective analysis. To analyze the data, Stata software (chi square, t test, Cox and logistic regression) was used. Participants were patients hospitalized for MI for the first time in 540 hospitals from April, 2012 to March, 2013...
May 2015: Diabetes Research and Clinical Practice
H Dieker, M A Brouwer, E V van Horssen, F M K J Hersbach, W R M Aengevaeren, F W A Verheugt, F W H M Bär
The latest meta-analysis comparing fibrinolysis with primary percutaneous intervention (PCI) has fuelled the discussion regarding the best reperfusion therapy for acute ST-elevation myocardial infarction. As far as patients presenting to centres with intervention facilities are concerned, the superiority of primary PCI has been unequivocally demonstrated. However, only a small proportion of patients with St-elevation myocardial infarction primarily present to an intervention centre, the majority go to a hospital without these facilities...
August 2004: Netherlands Heart Journal
Peter R Sinnaeve, Paul W Armstrong, Anthony H Gershlick, Patrick Goldstein, Robert Wilcox, Yves Lambert, Thierry Danays, Louis Soulat, Sigrun Halvorsen, Fernando Rosell Ortiz, Katleen Vandenberghe, Anne Regelin, Erich Bluhmki, Kris Bogaerts, Frans Van de Werf
BACKGROUND: In the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial, a pharmaco-invasive (PI) strategy was compared with primary percutaneous coronary intervention (pPCI) in ST-segment-elevation myocardial infarction patients presenting within 3 hours after symptom onset but unable to undergo pPCI within 1 hour. At 30 days, the PI approach was associated with a nominally but nonstatistically significant lower incidence of the composite primary end point of death, shock, congestive heart failure, and reinfarction when compared with pPCI...
September 30, 2014: Circulation
Nicolas Danchin, Nelson Dos Santos Teixeira, Etienne Puymirat
All guidelines recommend primary percutaneous coronary intervention as the default strategy for achieving reperfusion in ST-segment elevation myocardial infarction patients. These recommendations are based upon randomized trials which compared primary percutaneous coronary intervention with stand-alone intravenous fibrinolysis. Since the time these trials were performed, however, it has been shown in further trials that use of rescue percutaneous coronary intervention in patients without signs of reperfusion after lysis, and routine coronary angiography within 24 h of the administration of lysis for all other patients, substantially improved the results of intravenous fibrinolytic treatment...
August 2014: Revista Española de Cardiología
Nicolas Danchin, Etienne Puymirat, Philippe Gabriel Steg, Patrick Goldstein, François Schiele, Loïc Belle, Yves Cottin, Jean Fajadet, Khalife Khalife, Pierre Coste, Jean Ferrières, Tabassome Simon
BACKGROUND: Although primary percutaneous coronary intervention (pPCI) is the preferred reperfusion method for ST-segment-elevation myocardial infarction, it remains difficult to implement in many areas, and fibrinolytic therapy is still widely used. METHODS AND RESULTS: We assessed 5-year mortality in patients with ST-segment-elevation myocardial infarction from the French Registry of Acute ST-Elevation or Non-ST Elevation Myocardial Infarction (FAST-MI) 2005 according to use and type of reperfusion therapy...
April 22, 2014: Circulation
S Halvorsen, K Huber
Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI), as long as it can be delivered within 90-120 minutes from patient's first medical contact, and is the leading reperfusion strategy in most European countries. However, as PPCI cannot be offered in a timely manner to all patients, fibrinolytic therapy (FT) is the recommended choice in patients with an anticipated delay to PPCI of >90-120 minutes, presenting early after symptom onset and without contra-indications...
2014: Hämostaseologie
O Al Shammeri, LA Garcia
OBJECTIVE: Primary Percutaneous Coronary Intervention (PCI) is the treatment of choice for ST-segment Elevation Myocardial Infarction (STEMI) if performed within 90 minutes from first medical contact. However, primary PCI is only available for less than 25% of patients with STEMI. Early PCI or Pharmaco-invasive strategy has evolved from facilitated PCI but with more delayed timing from thrombolysis to PCI. AIM: Assess the safety and effectiveness of Early PCI. PATIENTS AND METHOD: We reviewed the data of the available therapy options for patients with STEMI...
January 2013: International Journal of Health Sciences
Saroj Mandal, Dhiman Kahali
No abstract text is available yet for this article.
June 2012: Journal of the Indian Medical Association
Sara Boccalini, Angela Bechini, Miriam Levi, Emila Tiscione, Roberto Gasparini, Paolo Bonanni
Community-acquired pneumonia (CAP) and invasive pneumococcal disease (IPD) are very relevant pathologies among elderly people (≥ 65 y old), with a consequent high disease burden. Immunization with the 23-valent pneumococcal polysaccharide vaccine (PPV23) has been differently implemented in the Italian regions in the past years, reaching overall low coverage rates even in those with medical indications. In 2010, the 13-valent pneumococcal conjugate vaccine (PCV13) became available and recommended in the universal Italian infant immunization program...
March 2013: Human Vaccines & Immunotherapeutics
Davide Capodanno, George Dangas
Primary percutaneous coronary intervention (PCI) is the preferred reperfusion method in patients with STelevation myocardial infarction (STEMI), when performed in a timely manner and by skilled operators. However, this strategy has shown to be limited in environments with lack of PCI facilities and delay in the first medical contact-toballoon time for logistic reasons. Pretreatment with fibrinolysis and/or glycoprotein IIb/IIIa inhibitors before PCI has the potential to provide early pharmacologic reperfusion before definitive PCI in STEMI patients...
August 2012: Current Cardiology Reviews
S Dharma, D A Juzar, I Firdaus, S Soerianata, A J Wardeh, J W Jukema
BACKGROUND: We studied the characteristics of ST-elevation myocardial infarction (STEMI) patients from a local acute coronary syndrome (ACS) registry in order to find and build an appropriate acute myocardial infarction (AMI) system of care in Jakarta, Indonesia. METHODS: Data were collected from the Jakarta Acute Coronary Syndrome (JAC) registry 2008-2009, which contained 2103 ACS patients, including 654 acute STEMI patients admitted to the National Cardiovascular Center Harapan Kita, Jakarta, Indonesia...
June 2012: Netherlands Heart Journal
David M Larson, Sue Duval, Scott W Sharkey, Ross F Garberich, James D Madison, Peter J Stokman, Timothy G Dirks, Robert K Westin, James L Harris, Timothy D Henry
AIMS: To determine the safety and efficacy of a pharmaco-invasive reperfusion strategy utilizing half-dose fibrinolysis combined with transfer for immediate percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients presenting to remote rural hospitals. Primary PCI is preferred for STEMI if performed in a timely manner. However, <20% of STEMI patients transferred for PCI in the USA have door-to-balloon times <2 h. METHODS AND RESULTS: Prospective data from the Level 1 MI programme were analysed...
May 2012: European Heart Journal
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