Invasive strategy following fibrinolysis in ST-elevation acute myocardial infarction

Rodolfo Pino, Francesco Clemenza, Caterina Gandolfo, Lucrezia Lo Cascio, Francesco Lo Giudice, Ubaldo Pulisano, Amerigo Stabile

Research output: Contribution to journalArticle

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Abstract

Background. A recognized drawback of ST-elevation acute myocardial infarction (STEMI) after fibrinolysis is persistent coronary occlusion or a less than TIMI 3 flow. The present study describes the results of systematic pre-discharge coronary angiography and revascularization, whenever indicated, following fibrinolytic therapy for STEMI. Methods. Consecutive patients admitted with the diagnosis of STEMI between April 1, 2000 and April 30, 2002 were included in the study. Patients with contraindications to thrombolytic therapy and/or patients not eligible for angiography were excluded. All patients received "accelerated" treatment with alteplase and had a coronary angiography at least 24 hours later, in order to perform, if anatomically feasible, angioplasty with stenting. Angioplasty of non-infarct-related coronary arteries was allowed. The mortality, reinfarction and new revascularization rates were evaluated during index hospitalization and up to 30 days and 6 months. Results. Eighty patients underwent cardiac catheterization at a median of 6.5 days following admission; in 86.3% of cases a patent infarct-related artery was found; in 71% of patients a coronary angioplasty was performed, with stenting in 88% of cases. Procedure-related complications were infrequent. No deaths occurred during hospitalization and at 30 days; at 6 months the mortality rate was 1.3%. In-hospital reinfarction occurred in 3.8% of patients, in 4% at 30 days and in 5.3% at 6 months. The rate of any new revascularization was 2.6% at 30 days and 11% at 6 months. Conclusions. Although obtained in a small observational study, our data, unlike those from previous studies, suggest that an invasive strategy after fibrinolysis in STEMI is safe and associated with low mortality and morbidity rates in the short and medium terms.

Original languageEnglish
Pages (from-to)688-692
Number of pages5
JournalItalian Heart Journal
Volume5
Issue number9
Publication statusPublished - Sep 2004

Fingerprint

Fibrinolysis
Angioplasty
Thrombolytic Therapy
Coronary Angiography
Mortality
Hospitalization
Coronary Occlusion
Tissue Plasminogen Activator
Cardiac Catheterization
ST Elevation Myocardial Infarction
Observational Studies
Coronary Vessels
Angiography
Arteries
Morbidity

Keywords

  • Corona angioplasty
  • Interventional procedures
  • Myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Pino, R., Clemenza, F., Gandolfo, C., Lo Cascio, L., Lo Giudice, F., Pulisano, U., & Stabile, A. (2004). Invasive strategy following fibrinolysis in ST-elevation acute myocardial infarction. Italian Heart Journal, 5(9), 688-692.

Invasive strategy following fibrinolysis in ST-elevation acute myocardial infarction. / Pino, Rodolfo; Clemenza, Francesco; Gandolfo, Caterina; Lo Cascio, Lucrezia; Lo Giudice, Francesco; Pulisano, Ubaldo; Stabile, Amerigo.

In: Italian Heart Journal, Vol. 5, No. 9, 09.2004, p. 688-692.

Research output: Contribution to journalArticle

Pino, R, Clemenza, F, Gandolfo, C, Lo Cascio, L, Lo Giudice, F, Pulisano, U & Stabile, A 2004, 'Invasive strategy following fibrinolysis in ST-elevation acute myocardial infarction', Italian Heart Journal, vol. 5, no. 9, pp. 688-692.
Pino, Rodolfo ; Clemenza, Francesco ; Gandolfo, Caterina ; Lo Cascio, Lucrezia ; Lo Giudice, Francesco ; Pulisano, Ubaldo ; Stabile, Amerigo. / Invasive strategy following fibrinolysis in ST-elevation acute myocardial infarction. In: Italian Heart Journal. 2004 ; Vol. 5, No. 9. pp. 688-692.
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AU - Lo Giudice, Francesco

AU - Pulisano, Ubaldo

AU - Stabile, Amerigo

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N2 - Background. A recognized drawback of ST-elevation acute myocardial infarction (STEMI) after fibrinolysis is persistent coronary occlusion or a less than TIMI 3 flow. The present study describes the results of systematic pre-discharge coronary angiography and revascularization, whenever indicated, following fibrinolytic therapy for STEMI. Methods. Consecutive patients admitted with the diagnosis of STEMI between April 1, 2000 and April 30, 2002 were included in the study. Patients with contraindications to thrombolytic therapy and/or patients not eligible for angiography were excluded. All patients received "accelerated" treatment with alteplase and had a coronary angiography at least 24 hours later, in order to perform, if anatomically feasible, angioplasty with stenting. Angioplasty of non-infarct-related coronary arteries was allowed. The mortality, reinfarction and new revascularization rates were evaluated during index hospitalization and up to 30 days and 6 months. Results. Eighty patients underwent cardiac catheterization at a median of 6.5 days following admission; in 86.3% of cases a patent infarct-related artery was found; in 71% of patients a coronary angioplasty was performed, with stenting in 88% of cases. Procedure-related complications were infrequent. No deaths occurred during hospitalization and at 30 days; at 6 months the mortality rate was 1.3%. In-hospital reinfarction occurred in 3.8% of patients, in 4% at 30 days and in 5.3% at 6 months. The rate of any new revascularization was 2.6% at 30 days and 11% at 6 months. Conclusions. Although obtained in a small observational study, our data, unlike those from previous studies, suggest that an invasive strategy after fibrinolysis in STEMI is safe and associated with low mortality and morbidity rates in the short and medium terms.

AB - Background. A recognized drawback of ST-elevation acute myocardial infarction (STEMI) after fibrinolysis is persistent coronary occlusion or a less than TIMI 3 flow. The present study describes the results of systematic pre-discharge coronary angiography and revascularization, whenever indicated, following fibrinolytic therapy for STEMI. Methods. Consecutive patients admitted with the diagnosis of STEMI between April 1, 2000 and April 30, 2002 were included in the study. Patients with contraindications to thrombolytic therapy and/or patients not eligible for angiography were excluded. All patients received "accelerated" treatment with alteplase and had a coronary angiography at least 24 hours later, in order to perform, if anatomically feasible, angioplasty with stenting. Angioplasty of non-infarct-related coronary arteries was allowed. The mortality, reinfarction and new revascularization rates were evaluated during index hospitalization and up to 30 days and 6 months. Results. Eighty patients underwent cardiac catheterization at a median of 6.5 days following admission; in 86.3% of cases a patent infarct-related artery was found; in 71% of patients a coronary angioplasty was performed, with stenting in 88% of cases. Procedure-related complications were infrequent. No deaths occurred during hospitalization and at 30 days; at 6 months the mortality rate was 1.3%. In-hospital reinfarction occurred in 3.8% of patients, in 4% at 30 days and in 5.3% at 6 months. The rate of any new revascularization was 2.6% at 30 days and 11% at 6 months. Conclusions. Although obtained in a small observational study, our data, unlike those from previous studies, suggest that an invasive strategy after fibrinolysis in STEMI is safe and associated with low mortality and morbidity rates in the short and medium terms.

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