A matched comparison of the combination of prehospital thrombolysis and standby rescue angioplasty with primary angioplasty.

Abstract

This study sought to assess the rate of acute Thrombolysis In Myocardial Infarction (TIMI) trial grade 3 patency that can be achieved with the combination of prehospital thrombolysis and standby rescue angioplasty in acute myocardial infarction. No large angiographic study has been performed after prehospital thrombolysis to determine the 90-minute TIMI 3 patency rate in the infarct-related artery. Hospital outcome and artery patency were compared to 170 matched patients treated with primary angioplasty. Prehospital thrombolysis was applied 151+/-61 minutes after the onset of pain in 170 patients (56+/-12 years, 86% men), using recombinant tissue-type plasminogen activator, streptokinase, or eminase. Emergency 90-minute angiography was performed in every case. All patients in whom thrombolysis failed underwent rescue angioplasty. After thrombolysis alone, TIMI grade 3 flow in the infarct-related artery was observed in 108 patients (64%), TIMI grade 2 in 12 (7%), and TIMI grade 0 or 1 in 50 (29%). Rescue angioplasty was successful in 47 of 50 attempts. Overall, TIMI 3 patency was achieved in 91%, and additionally TIMI 2 flow in 7% of patients, an average of 113+/-39 minutes after thrombolysis and 55+19 minutes after admission. Therefore, < 2 hours after thrombolysis, only 2% of patients had persistent occlusion (TIMI 0 or 1) of the infarct-related artery. In-hospital mortality was 4% overall (7 of 170), and 3% in the 155 patients in whom TIMI 3 was obtained during the acute phase. Severe hemorrhagic complications occurred in 14 patients (8%) with 2 fatal cerebral hemorrhages (7% of patients required transfusions). The matched comparison with primary PTCA showed no significant difference in hospital outcome. Combined prehospital thrombolysis, 90-minute angiography, and rescue angioplasty yield a high rate of acute TIMI 3 patency rate early after thrombolysis and hospital admission. A randomized, prospective comparison between these 2 reperfusion strategies may be now warranted.

• Authors: J M Juliard, D Himbert, P Cristofini, J C Desportes, M Magne, J L Golmard, P Aubry, H Benamer, A Boccara, G J Karrillon, P G Steg
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 83 Issue 3 Pg. 305-10 (Feb 01 1999) ISSN: 0002-9149 [Print] United States
• PMID: 10072213 (Publication Type: Clinical Trial, Comparative Study, Journal Article)

Chemical References

• Fibrinolytic Agents
• Recombinant Proteins
• Anistreplase
• Streptokinase
• Tissue Plasminogen Activator

Topics

• Adult
• Aged
• Aged, 80 and over
• Angioplasty, Balloon, Coronary
• Anistreplase (therapeutic use)
• Combined Modality Therapy
• Coronary Angiography
• Emergency Medical Services
• Female
• Fibrinolytic Agents (therapeutic use)
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Myocardial Infarction (diagnostic imaging, mortality, therapy)
• Recombinant Proteins
• Recurrence
• Streptokinase (therapeutic use)
• Survival Rate
• Thrombolytic Therapy
• Tissue Plasminogen Activator (therapeutic use)
• Treatment Outcome