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Pharmaco-invasive strategy

El-Zahraa M Sultan, Hoda M Rabea, Khaled R Abdelmeguid, Hesham B Mahmoud
The purpose of the study was to investigate the safety and efficacy of transradial artery approach (TRA) in STEMI patients who reperfused early (≤3 h from symptoms onset) or late (>3 h from symptoms onset) by either PPCI or pharmaco-invasive strategy (PI), thrombolysis followed by CA. Therefore, a total 143 STEMI patients (who were presented within 12 h from symptoms onset or 12-24 h with an evidence of ongoing ischemia or suffered from an acute STEMI were randomized for either PI or PPCI. Eighty-two patients were assigned to PI arm while the rest assigned were to PPCI arm...
March 2018: The Egyptian heart journal: (EHJ): official bulletin of the Egyptian Society of Cardiology
Manuel Chacón-Diaz, Alejandro Vega, Ofelia Aráoz, Patricia Ríos, Roberto Baltodano, Fernando Villanueva, Alexander Montesinos, Jorge Martos, John Zevallos, David Miranda, Jorge Gutierrez, José Carasas, Alex Pecho, Sandra Negrón, Henry Anchante, Nassip Llerena, German Yabar, Javier Chumbe, Sara Ramírez, Marco Lazo, Jorge Sotomayor, Marco López, Carlos Perez
OBJECTIVE: To determine the epidemiological characteristics, treatment, reperfusion strategies and in-hospital adverse events of patients with ST elevation myocardial infarction in Peru. METHODS: Observational, prospective multicentre study in patients over 18 years admitted to hospital with a diagnosis of ST elevation myocardial infarction. RESULTS: A total of 396 patients were enrolled in the registry during February 2016 to February 2017...
January 2, 2018: Archivos de Cardiología de México
Sundeep Mishra
No abstract text is available yet for this article.
September 2017: Indian Heart Journal
Alejandro Farah, Alejandro Barbagelata
Reperfusion therapy decreases myocardium damage during an acute coronary event and consequently mortality. However, there are unmet needs in the treatment of acute myocardial infarction, consequently mortality and heart failure continue to occur in about 10% and 20% of cases, respectively. Different strategies could improve reperfusion. These strategies, like generation of warning sign recognition and being initially assisted and transferred by an emergency service, could reduce the time to reperfusion. If the first electrocardiogram is performed en route, it can be transmitted and interpreted in a timely manner by a specialist at the receiving center, bypassing community hospitals without percutaneous coronary intervention capabilities...
2017: F1000Research
Jun Pu, Song Ding, Heng Ge, Yaling Han, Jinchen Guo, Rong Lin, Xi Su, Heng Zhang, Lianglong Chen, Ben He
BACKGROUND: Timely primary percutaneous coronary intervention (PPCI) cannot be offered to all patients with ST-segment-elevation myocardial infarction (STEMI). Pharmaco-invasive (PhI) strategy has been proposed as a valuable alternative for eligible patients with STEMI. We conducted a randomized study to compare the efficacy and safety of a PhI strategy with half-dose fibrinolytic regimen versus PPCI in patients with STEMI. METHODS: The EARLY-MYO trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction) was an investigator-initiated, prospective, multicenter, randomized, noninferiority trial comparing a PhI strategy with half-dose alteplase versus PPCI in patients with STEMI 18 to 75 years of age presenting ≤6 hours after symptom onset but with an expected PCI-related delay...
October 17, 2017: Circulation
Carlos Martínez-Sánchez, Alexandra Arias-Mendoza, Héctor González-Pacheco, Diego Araiza-Garaygordobil, Luis Alfonso Marroquín-Donday, Jorge Padilla-Ibarra, Carlos Sierra-Fernández, Alfredo Altamirano-Castillo, Amada Álvarez-Sangabriel, Francisco Javier Azar-Manzur, José Luis Briseño-de la Cruz, Salvador Mendoza-García, Yigal Piña-Reyna, Marco Antonio Martínez-Ríos
Mexico has been positioned as the country with the highest mortality attributed to myocardial infarction among the members of the Organization for Economic Cooperation and Development. This rate responds to multiple factors, including a low rate of reperfusion therapy and the absence of a coordinated system of care. Primary angioplasty is the reperfusion method recommended by the guidelines, but requires multiple conditions that are not reached at all times. Early pharmacological reperfusion of the culprit coronary artery and early coronary angiography (pharmacoinvasive strategy) can be the solution to the logistical problem that primary angioplasty rises...
April 2017: Archivos de Cardiología de México
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...
February 2017: 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
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