Download Mechanical Reperfusion for STEMI: From Randomized Trials to by Giuseppe De Luca, Alexandra Lansky PDF
By Giuseppe De Luca, Alexandra Lansky
As a number one reason for demise in constructed nations, ST-segment elevation myocardial infarction and its a number of cures are of serious situation to these within the cardiology box. this article offers evidence-based chapters that provide clinicians with real-life events and methods to regard STEMI sufferers extra successfully and at a swifter velocity. A hugely illustrated and completely referenced resource, this finished textual content offers either a systematic history and a pragmatic evaluation of the invasive administration of STEMI sufferers.
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Extra info for Mechanical Reperfusion for STEMI: From Randomized Trials to Clinical Practice
With the exception of a higher rate of emergent PCI in the deferred PTCA group (16% vs. 01), there were no differences in outcomes between the two groups. A substudy of the Thrombolysis in Myocardial Infarction (TIMI)-II study (TIMI-IIA) evaluated the role of immediate compared with delayed PTCA after t-PA in 389 patients (15). This study confirmed the findings of the early studies showing no difference in the primary end point of ejection fraction at one-year follow-up. 0% vs. 4% vs. 01). Facilitated PCI did not show benefits in mortality in an initial metaanalysis of the early trials (16) that was explained by higher rate of procedural complications and, especially, higher bleeding rates, that are well known related to worse survival (17).
Late Assessment of Thrombolytic Efficacy (LATE) study with alteplase 6–24 hours after onset of acute myocardial infarction. Lancet 1993; 342(8874):759–766. 23. Schomig A, Mehilli J, Antoniucci D, et al. Mechanical reperfusion in patients with acute myocardial infarction presenting more than 12 hours from symptom onset: A randomized controlled trial. JAMA 2005; 293(23):2865–2872. 24. Morrison LJ, Verbeek PR, McDonald AC, et al. Mortality and prehospital thrombolysis for acute myocardial infarction: A meta-analysis.
More recently, data from the EMERALD trial (9) have shown a clear relationship between time-to-treatment, myocardial perfusion, and infarct size analyzed by scintigraphy. Similar finding has been observed in a pooled analysis of four trials performed by Stone et al. (10). A recent study conducted by Tarantini et al. (11) has evaluated the impact of time-to-treatment on infarct size, estimated by MRI. Supporting data by De Luca et al. (6), they observed a significant increase in infarct size by every 30 minutes delay to treatment.