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Facilitated primary coronary intervention with abciximab and very low dose of alteplase during off-hours compared with direct primary intervention during regular hours
- Source :
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac AngiographyInterventions. 65(4)
- Publication Year :
- 2005
-
Abstract
- In patients with acute myocardial infarction (AMI), the off-hour presentation is one of the major determinants of door-to-balloon delay. Moreover, the nighttime presentation is associated with increased mortality after primary coronary intervention (PCI). The prompt starting of a therapy able to start recanalization of the infarct-related artery before intervention might improve the results of off-hour primary PCI. We compared the outcome of 212 consecutive patients with AMI undergoing either direct or facilitated PCI according to the hour of presentation. Patients arriving off-hours were pretreated with alteplase (20 mg) and abciximab and underwent facilitated PCI. Patients presenting on-hours underwent direct PCI. A basal Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 was observed in 1.0% of patients undergoing direct PCI and in 44% of patients undergoing facilitated PCI (P = 0.001). More patients starting PCI with a TIMI 3 flow achieved a postinterventional fast TIMI frame count (72.0% vs. 38.8% direct PCI group vs. 34.9% facilitated PCI group with basal TIMI 0-2; P = 0.001) and a TIMI perfusion grade 3 (66.0% vs. 38.8% direct PCI group vs. 39.7% facilitated PCI group with basal TIMI 0-2; P = 0.004). Preinterventional TIMI flow grade 3 was associated with a higher gain in left ventricular ejection fraction at 1 month (10.9% +/- 6.4% vs. 7.0% +/- 9.6% direct PCI group vs. 6.1% +/- 6.0% facilitated PCI group with basal TIMI 0-2; P = 0.005). No significant difference was observed in major bleedings, although there was a trend toward a higher risk in the facilitated PCI group. Patients in the facilitated PCI group achieving a basal TIMI 3 flow showed improved myocardial reperfusion and better left ventricular function recovery. Bleeding complications associated with combination therapy remained an important concern.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Abciximab
Myocardial Infarction
Coronary Angiography
Ventricular Function, Left
Immunoglobulin Fab Fragments
Postoperative Complications
Fibrinolytic Agents
Angioplasty
Internal medicine
Coronary Circulation
medicine
Humans
Radiology, Nuclear Medicine and imaging
cardiovascular diseases
Myocardial infarction
Hospital Mortality
Angioplasty, Balloon, Coronary
Aged
Ejection fraction
business.industry
Antibodies, Monoclonal
Stroke Volume
General Medicine
Thrombolysis
Middle Aged
medicine.disease
surgical procedures, operative
Treatment Outcome
Italy
Tissue Plasminogen Activator
Conventional PCI
Cardiology
Drug Therapy, Combination
Female
Cardiology and Cardiovascular Medicine
business
Perfusion
TIMI
Platelet Aggregation Inhibitors
medicine.drug
Follow-Up Studies
Subjects
Details
- ISSN :
- 15221946
- Volume :
- 65
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac AngiographyInterventions
- Accession number :
- edsair.doi.dedup.....97335ba44ceba0a6458ac2410330de19