BACKGROUND: Current ST-segment elevation myocardial infarction guidelines regarding reperfusion strategy are based on trials conducted before the application of routine invasive evaluation after thrombolysis. Modern thrombolysis may affect the previously observed mortality difference between primary percutaneous coronary intervention (PPCI) and thrombolysis. METHODS: In-hospital mortality was prospectively assessed in 5295 patients with ST-segment elevation myocardial infarction admitted to 73 Belgian hospitals from July 1, 2007, through December 31, 2009. A total of 4574 patients (86.4%) were treated with PPCI and 721 (13.6%) received thrombolysis; of these thrombolysis patients, 603 (83.6%) underwent subsequent invasive evaluation. The Thrombolysis in Myocardial Infarction risk score was used to stratify the study population by low (n = 1934), intermediate (n = 2382), and high (n = 979) risk. RESULTS: In-hospital mortality in the PPCI patients was 5.9% vs 6.6% in the thrombolysis patients. After adjustment for differences in baseline risk profile, a significant mortality benefit was only present in the high-risk groups: 23.7% in the PPCI patients vs 30.6% in the thrombolysis patients. For patients not at high risk, the mortality difference was marginal. For low-risk patients, mortality was 0.3% in the PPCI patients vs 0.4% in the thrombolysis patients. For intermediate-risk patients, mortality was 2.9% in the PPCI patients vs 3.1% in the thrombolysis patients. Subgroup analysis revealed that the mortality benefit of PPCI compared with early thrombolysis (door-to-needle time <30 minutes) was offset if the door-to-balloon time exceeded 60 minutes. CONCLUSIONS: Modern thrombolytic strategies have substantially attenuated the absolute mortality benefit of PPCI over thrombolysis, particularly in patients not at high risk. Our study findings suggest that target door-to-balloon time should be less than 60 minutes to maintain the lowest mortality rates.
BACKGROUND: Current ST-segment elevation myocardial infarction guidelines regarding reperfusion strategy are based on trials conducted before the application of routine invasive evaluation after thrombolysis. Modern thrombolysis may affect the previously observed mortality difference between primary percutaneous coronary intervention (PPCI) and thrombolysis. METHODS: In-hospital mortality was prospectively assessed in 5295 patients with ST-segment elevation myocardial infarction admitted to 73 Belgian hospitals from July 1, 2007, through December 31, 2009. A total of 4574 patients (86.4%) were treated with PPCI and 721 (13.6%) received thrombolysis; of these thrombolysis patients, 603 (83.6%) underwent subsequent invasive evaluation. The Thrombolysis in Myocardial Infarction risk score was used to stratify the study population by low (n = 1934), intermediate (n = 2382), and high (n = 979) risk. RESULTS: In-hospital mortality in the PPCIpatients was 5.9% vs 6.6% in the thrombolysis patients. After adjustment for differences in baseline risk profile, a significant mortality benefit was only present in the high-risk groups: 23.7% in the PPCIpatients vs 30.6% in the thrombolysis patients. For patients not at high risk, the mortality difference was marginal. For low-risk patients, mortality was 0.3% in the PPCIpatients vs 0.4% in the thrombolysis patients. For intermediate-risk patients, mortality was 2.9% in the PPCIpatients vs 3.1% in the thrombolysis patients. Subgroup analysis revealed that the mortality benefit of PPCI compared with early thrombolysis (door-to-needle time <30 minutes) was offset if the door-to-balloon time exceeded 60 minutes. CONCLUSIONS: Modern thrombolytic strategies have substantially attenuated the absolute mortality benefit of PPCI over thrombolysis, particularly in patients not at high risk. Our study findings suggest that target door-to-balloon time should be less than 60 minutes to maintain the lowest mortality rates.
Authors: Els H Vandecasteele; Marc De Buyzere; Sofie Gevaert; Antoine de Meester; Carl Convens; Philippe Dubois; Jean Boland; Peter Sinnaeve; Herbert De Raedt; Pascal Vranckx; Patrick Coussement; Patrick Evrard; Christophe Beauloye; Marc Renard; Marc J Claeys Journal: Clin Res Cardiol Date: 2013-07-26 Impact factor: 5.460
Authors: Marc J Claeys; Peter R Sinnaeve; Carl Convens; Philippe Dubois; Jean Boland; Pascal Vranckx; Sofie Gevaert; Antoine de Meester; Patrick Coussement; Herbert De Raedt; Christophe Beauloye; Marc Renard; Christiaan Vrints; Patrick Evrard Journal: Eur Heart J Acute Cardiovasc Care Date: 2012-04
Authors: Juho Viikilä; Jyrki Lilleberg; Ilkka Tierala; Mikko Syvänne; Markku Kupari; Veikko Salomaa; Markku S Nieminen Journal: Eur Heart J Acute Cardiovasc Care Date: 2013-08-21
Authors: 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 Journal: J Am Heart Assoc Date: 2016-10-06 Impact factor: 5.501
Authors: Jabir A; Anoop Mathew; Sunitha Viswanathan; Ashraf S M; Placid Sebastian; Prasannakumar C K; George Koshy A; Sunil Pisharody; Rony Mathew; L Jeyasheelan Journal: Indian Heart J Date: 2017-05-31