INTRODUCTION AND OBJECTIVES: Pharmacoinvasive strategy represents an attractive alternative to primary angioplasty. Using cardiovascular magnetic resonance imaging we compared the left ventricular outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction. METHODS: Cardiovascular magnetic resonance was performed 1 week and 6 months after infarction in two consecutive cohorts of patients included in a prospective university hospital ST-segment elevation myocardial infarction registry. During the period 2004-2006, 151 patients were treated with pharmacoinvasive strategy (thrombolysis followed by routine non-immediate angioplasty). During the period 2007-2008, 93 patients were treated with primary angioplasty. A propensity score matched population was also evaluated. RESULTS: At 1-week cardiovascular magnetic resonance, pharmacoinvasive strategy and primary angioplasty patients showed a similar extent of area at risk (29±15 vs. 29±17%, P=.9). Non-significant differences were detected by cardiovascular magnetic resonance at 1 week and at 6 months in infarct size, salvaged myocardium, microvascular obstruction, ejection fraction, end-diastolic volume index and end-systolic volume index (P>.2 in all cases). The same trend was observed in 1-to-1 propensity score matched patients. The rate of major adverse cardiac events (death and/or re-infarction) at 1 year was 6% in pharmacoinvasive strategy and 7% in primary angioplasty patients (P=.7). CONCLUSIONS: A pharmacoinvasive strategy including thrombolysis and routine non-immediate angioplasty represents a widely available and logistically attractive approach that yields identical short-term and long-term cardiovascular magnetic resonance-derived left ventricular outcome compared to primary angioplasty.
INTRODUCTION AND OBJECTIVES: Pharmacoinvasive strategy represents an attractive alternative to primary angioplasty. Using cardiovascular magnetic resonance imaging we compared the left ventricular outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction. METHODS: Cardiovascular magnetic resonance was performed 1 week and 6 months after infarction in two consecutive cohorts of patients included in a prospective university hospital ST-segment elevation myocardial infarction registry. During the period 2004-2006, 151 patients were treated with pharmacoinvasive strategy (thrombolysis followed by routine non-immediate angioplasty). During the period 2007-2008, 93 patients were treated with primary angioplasty. A propensity score matched population was also evaluated. RESULTS: At 1-week cardiovascular magnetic resonance, pharmacoinvasive strategy and primary angioplasty patients showed a similar extent of area at risk (29±15 vs. 29±17%, P=.9). Non-significant differences were detected by cardiovascular magnetic resonance at 1 week and at 6 months in infarct size, salvaged myocardium, microvascular obstruction, ejection fraction, end-diastolic volume index and end-systolic volume index (P>.2 in all cases). The same trend was observed in 1-to-1 propensity score matched patients. The rate of major adverse cardiac events (death and/or re-infarction) at 1 year was 6% in pharmacoinvasive strategy and 7% in primary angioplasty patients (P=.7). CONCLUSIONS: A pharmacoinvasive strategy including thrombolysis and routine non-immediate angioplasty represents a widely available and logistically attractive approach that yields identical short-term and long-term cardiovascular magnetic resonance-derived left ventricular outcome compared to primary angioplasty.
Authors: Gianluca Pontone; Daniele Andreini; Erika Bertella; Monica Loguercio; Marco Guglielmo; Andrea Baggiano; Giovanni Donato Aquaro; Saima Mushtaq; Sara Salerni; Paola Gripari; Carmen Rossi; Chiara Segurini; Edoardo Conte; Virginia Beltrama; Marta Giovannardi; Fabrizio Veglia; Andrea Igoren Guaricci; Antonio L Bartorelli; Piergiuseppe Agostoni; Mauro Pepi; Pier Giorgio Masci Journal: Eur Radiol Date: 2015-10-29 Impact factor: 5.315
Authors: Idan Roifman; Nilesh R Ghugre; Tasnim Vira; Mohammad I Zia; Anna Zavodni; Mihaela Pop; Kim A Connelly; Graham A Wright Journal: BMC Cardiovasc Disord Date: 2016-10-14 Impact factor: 2.298
Authors: Felipe José de Andrade Falcão; Cláudia Maria Rodrigues Alves; Adriano Henrique Pereira Barbosa; Adriano Caixeta; José Marconi Almeida Sousa; José Augusto Marcondes Souza; Amaury Amaral; Luiz Carlos Wilke; Fátima Cristina A Perez; Iran Gonçalves Júnior; Edson Stefanini; Antônio Carlos Carvalho Journal: Clinics (Sao Paulo) Date: 2013-12 Impact factor: 2.365