Pharmacoinvasive therapy for ST elevation myocardial infarction in China: a pilot study.

Abstract

Most patients with acute ST-elevation myocardial infarction (STEMI) cannot receive timely primary percutaneous coronary intervention (PCI) because of lack of facilities or delays in patient transfer or catheterization team mobilization. In these patients, early routine post-thrombolysis PCI might be a reasonable, useful strategy. This study investigated feasibility and safety of early PCI after successful half-dose alteplase reperfusion in a Chinese population. Patients with STEMI received half-dose alteplase if expected time delay to PCI was ≥90 min. Patients who reached clinical criteria of successful thrombolysis reperfusion were recommended to undergo diagnostic angiography within 3-24 h after thrombolysis. Patients with residual stenosis ≥70% in the infarct-related artery underwent PCI, regardless of flow or patency status. Epicardial arterial flow was assessed using thrombolysis in myocardial infarction (TIMI) flow grade and TIMI frame count (CTFC). Myocardial perfusion was assessed using myocardial blush grade (MBG) and TIMI myocardial perfusion frame count (TMPFC). Forty-nine patients were enrolled and underwent diagnostic angiography 3-11.3 h (median 6.5 h) after thrombolysis. Forty-six patients underwent PCI. No procedure-related complications occurred, except two patients who had no reflow after PCI. Twenty-two (47.8%) patients had TIMI grade 3 flow before PCI and 33 (71.7%) after PCI. CTFC was significantly improved after PCI (48.5 ± 32.1 vs. 37.9 ± 25.6, P = 0.01). MBG and TMPFC exhibited a similar improving trend after PCI, and the best myocardial perfusion tended to be achieved 3-12 h after lysis. During the 30-day follow-up, there were two deaths. The composite end point of death, cardiogenic shock, heart failure, reinfarction, and recurrent ischemia occurred in four patients. TIMI minor bleeding occurred in four patients. No TIMI major bleeding and stroke occurred. Early routine PCI after half-dose alteplase thrombolysis in Chinese population appears feasible. A larger clinical trial should be designed to further elucidate its efficacy and safety. Early PCI after thrombolysis in STEMI: The EARLY-PCI pilot feasibility study, ChiCTR-TNC-11001363.

• Authors: Ling-hong Shen, Fang Wan, Long Shen, Song Ding, Xin-rong Gong, Zhi-qing Qiao, Yong-ping Du, Wei Song, Jie-yan Shen, Shu-xuan Jin, Jun Pu, Tian-bao Yao, Li-sheng Jiang, Wei-zhen Li, Guo-wei Zhou, Shao-wen Liu, Ya-ling Han, Ben He
• Journal: Journal of thrombosis and thrombolysis (J Thromb Thrombolysis) Vol. 33 Issue 1 Pg. 101-8 (Jan 2012) ISSN: 1573-742X [Electronic] Netherlands
• PMID: 22094974 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Heparin
• Tissue Plasminogen Activator

Topics

• Aged
• Angioplasty, Balloon, Coronary (methods)
• China (epidemiology)
• Feasibility Studies
• Female
• Heparin (therapeutic use)
• Humans
• Male
• Middle Aged
• Myocardial Infarction (epidemiology, therapy)
• Pilot Projects
• Thrombolytic Therapy (methods)
• Tissue Plasminogen Activator (therapeutic use)