Copyright © 2001 by the European Society of Cardiology.
Outcome after combined reperfusion therapy for acute myocardial infarction, combining pre-hospital thrombolysis with immediate percutaneous coronary intervention and stent
a Institut Cardiovasculaire Paris Sud, Quincy, France
b Institut Cardiovasculaire Paris Sud, Massy, France
c Institut Cardiovasculaire Paris Sud, Antony, France
d The Service d'Aide Médicale d'Urgence, Melun 77, France
e Créteil 94, France
f Corbeil Essonnes 91, France
revised October 10, 2000; accepted October 11, 2000
Abstract
Background Primary therapies in acute myocardial infarction (thrombolysis and angioplasty) have inherent limitations which may be overcome by combining them. So far, no trial has demonstrated a clinical benefit in combining mechanical and pharmacological treatment strategies.
Methods From January 1995 to December 1999, out of 1010 patients admitted to our institution for acute myocardial infarction, 148 had received pre-hospital full dose thrombolysis within 12h of onset. One hundred and thirty-one patients were included and underwent immediate angioplasty and stenting when suitable, independent of the infarct-artery patency (TIMI grade flow 0–3). In-hospital outcome was assessed and clinical information was collected for a mean (±SD) of 2±1 years.
Results Ninety-minute angiography revealed a patent (TIMI grade 3) infarct artery in 65 patients (49%). Immediate angioplasty was performed in 119 patients (91%) with stent implantation in 114 (96%). Angioplasty achieved TIMI 2, 3 flow in 98%, and complete patency (TIMI 3 flow) in 92%. Six other patients underwent deferred revascularization (surgery in one patient, angioplasty in five) and six received medical treatment. Stent thrombosis and reinfarction occurred in three patients (2·3%). In-hospital death occurred in six patients (4·6%), including four patients presenting with cardiogenic shock. Major bleeding was observed in 2·3% of cases. No patient had emergency surgery. Freedom from death and reinfarction at 2 years was 90% and freedom from death, reinfarction and target vessel revascularization was 83%.
Conclusion A strategy of combined reperfusion using full dose pre-hospital thrombolysis and immediate angioplasty with stent implantation in a non-selected acute myocardial infarction population is safe and achieves high and early patency rates. This preliminary experience suggests that a combined strategy in acute myocardial infarction may have a significant impact on both early and long-term outcomes.
Key Words: Myocardial infarction, angioplasty, stents, thrombolysis
f1 Correspondence: Dr Christophe Loubeyre, Hôpital Claude Galien, Institut Cardiovasculaire Paris Sud, 20 route de Boussy, 91480 Quincy sous Sénart, France.
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