OBJECTIVES: This study was conducted to assess whether coronary stenting produces better results compared with balloon angioplasty in patients with acute myocardial infarction (AMI) after failed thrombolysis. BACKGROUND: Little evidence exists on the value of rescue mechanical reperfusion after failed thrombolysis. METHODS: This open-label, randomized study enrolled 181 patients with AMI referred for failed thrombolysis performed within the previous 24 h. The patients had to have a Thrombolysis In Myocardial Infarction (TIMI) flow grade of <or=2 in coronary angiography. Patients were randomly assigned to coronary stenting (90 patients) or coronary balloon angioplasty (91 patients). Salvage index (proportion of initial perfusion defect salvaged by rescue intervention), which was obtained by paired scintigraphic studies performed 7 to 10 days apart, was the primary end point of the trial. One-year clinical follow-up was assessed. RESULTS:Myocardial salvage index (median [25th, 75th percentiles]) was significantly greater in the stent group than in the angioplasty group (0.35 [0.24, 0.56] vs. 0.25 [0.04, 0.43]; p = 0.005). Major bleeding occurred in four patients (4%) in the stent group and four patients (4%) in the angioplasty group. One-year mortality was 8% (7 patients) in the stent group versus 12% (11 patients) in the angioplasty group (relative risk, 0.6; 95% confidence interval 0.2 to 1.6; p = 0.35). CONCLUSIONS: Patients with AMI and failed thrombolysis benefit from rescue mechanical reperfusion in terms of myocardial salvage. Coronary stenting is associated with a greater myocardial salvage in this setting compared with coronary balloon angioplasty.
RCT Entities:
OBJECTIVES: This study was conducted to assess whether coronary stenting produces better results compared with balloon angioplasty in patients with acute myocardial infarction (AMI) after failed thrombolysis. BACKGROUND: Little evidence exists on the value of rescue mechanical reperfusion after failed thrombolysis. METHODS: This open-label, randomized study enrolled 181 patients with AMI referred for failed thrombolysis performed within the previous 24 h. The patients had to have a Thrombolysis In Myocardial Infarction (TIMI) flow grade of <or=2 in coronary angiography. Patients were randomly assigned to coronary stenting (90 patients) or coronary balloon angioplasty (91 patients). Salvage index (proportion of initial perfusion defect salvaged by rescue intervention), which was obtained by paired scintigraphic studies performed 7 to 10 days apart, was the primary end point of the trial. One-year clinical follow-up was assessed. RESULTS: Myocardial salvage index (median [25th, 75th percentiles]) was significantly greater in the stent group than in the angioplasty group (0.35 [0.24, 0.56] vs. 0.25 [0.04, 0.43]; p = 0.005). Major bleeding occurred in four patients (4%) in the stent group and four patients (4%) in the angioplasty group. One-year mortality was 8% (7 patients) in the stent group versus 12% (11 patients) in the angioplasty group (relative risk, 0.6; 95% confidence interval 0.2 to 1.6; p = 0.35). CONCLUSIONS:Patients with AMI and failed thrombolysis benefit from rescue mechanical reperfusion in terms of myocardial salvage. Coronary stenting is associated with a greater myocardial salvage in this setting compared with coronary balloon angioplasty.
Authors: Hans Erik Bøtker; Derek Hausenloy; Ioanna Andreadou; Salvatore Antonucci; Kerstin Boengler; Sean M Davidson; Soni Deshwal; Yvan Devaux; Fabio Di Lisa; Moises Di Sante; Panagiotis Efentakis; Saveria Femminò; David García-Dorado; Zoltán Giricz; Borja Ibanez; Efstathios Iliodromitis; Nina Kaludercic; Petra Kleinbongard; Markus Neuhäuser; Michel Ovize; Pasquale Pagliaro; Michael Rahbek-Schmidt; Marisol Ruiz-Meana; Klaus-Dieter Schlüter; Rainer Schulz; Andreas Skyschally; Catherine Wilder; Derek M Yellon; Peter Ferdinandy; Gerd Heusch Journal: Basic Res Cardiol Date: 2018-08-17 Impact factor: 17.165
Authors: Vinod Jorapur; Terje K Steigen; Christopher E Buller; Vladimír Dzavík; John G Webb; Bradley H Strauss; Eunice E S Yeoh; Peter Kurray; Leszek Sokalski; Mauricio C Machado; Shari S Kronsberg; Gervasio A Lamas; Judith S Hochman; G B John Mancini Journal: Catheter Cardiovasc Interv Date: 2008-11-15 Impact factor: 2.692
Authors: On Topaz; Douglas Ebersole; Johannes B Dahm; Edwin L Alderman; Hooman Madyoon; Kishor Vora; John D Baker; David Hilton; Tony Das Journal: Lasers Med Sci Date: 2007-04-11 Impact factor: 3.161