Thorombolytic therapy with rescue percutaneous coronary intervention versus primary percutaneous coronary intervention in patients with acute myocardial infarction : a multicenter randomized clinical trial
BACKGROUND: Although thrombolytic therapy with rescue percutaneous coronary intervention (PCI) is a common treatment strategy for ST-segment elevation acute myocardial infarction (STEMI), scant data are available on its efficacy relative to primary PCI, and comparison was therefore the aim of this study.
METHODS: This multicenter, open-label, randomized, parallel trial was conducted in 12 hospitals on patients (age < or = 70 years) with STEMI who presented within 12 hours of symptom onset (mean interval > 3 hours). Patients were randomized to three groups: primary PCI group (n = 101); recombinant staphylokinase (r-Sak) group (n = 104); and recombinant tissue-type plasminogen activator (rt-PA) group (n = 106). For all patients allocated to the thrombolytic therapy arm, coronary angiography was performed at 90 minutes after drug therapy to confirm infarct-related artery (IRA) patency; rescue PCI was performed in cases with TIMI flow grade < or = 2. Bare-metal stent implantation was planned for all patients.
RESULTS: After randomization it required an average of 113.4 minutes to start thrombolytic therapy (door-to-needle time) and 141.2 minutes to perform first balloon inflation in the IRA (door to balloon time). Rates of IRA patency (TIMI flow grade 2 or 3) and TIMI flow grade 3 were significantly lower in the thrombolysis group at 90 minutes after drug therapy than in the primary PCI group at the end of the procedure (70.5% vs. 98.0%, P < 0.0001, and 53.0% vs. 85.9%, P < 0.0001, respectively). Rescue PCI with stenting was performed in 117 patients (55.7%) in the thrombolytic therapy arm. Rates of patency and TIMI flow grade 3 were still significantly lower in the rescue PCI than in the primary PCI group (88.9% vs. 97.9%, P = 0.0222, and 68.4% vs. 85.0%, P = 0.0190, respectively). At 30 days post-therapy, mortality rate was significantly higher in the thrombolysis combined with rescue PCI group than in primary PCI group (7.1% vs. 0, P = 0.0034). Rates of death/MI and bleeding complications were significantly higher in the thrombolysis with rescue PCI group than in the primary PCI group (10.0% vs. 1.0%, P = 0.0380, and 28.10% vs. 8.91%, P = 0.0001, respectively).
CONCLUSIONS: Thrombolytic therapy with rescue PCI was associated with significantly lower rates of coronary patency and TIMI flow grade 3, but with significantly higher rates of mortality, death/MI and hemorrhagic complications at 30 days, as compared with primary PCI in this group of Chinese STEMI patients with late presentation and delayed treatments.
| Errataetall: |
CommentIn: Chin Med J (Engl). 2010 Jun;123(11):1363-4. - PMID 20819586 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2010 |
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| Erschienen: |
2010 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:123 |
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| Enthalten in: |
Chinese medical journal - 123(2010), 11 vom: 05. Juni, Seite 1365-72 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Gao, Run-lin [VerfasserIn] |
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| Themen: |
Fibrinolytic Agents |
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| Anmerkungen: |
Date Completed 22.12.2010 Date Revised 07.09.2010 published: Print CommentIn: Chin Med J (Engl). 2010 Jun;123(11):1363-4. - PMID 20819586 Citation Status MEDLINE |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM201368900 |
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| 041 | |a eng | ||
| 100 | 1 | |a Gao, Run-lin |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Thorombolytic therapy with rescue percutaneous coronary intervention versus primary percutaneous coronary intervention in patients with acute myocardial infarction |b a multicenter randomized clinical trial |
| 264 | 1 | |c 2010 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 22.12.2010 | ||
| 500 | |a Date Revised 07.09.2010 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Chin Med J (Engl). 2010 Jun;123(11):1363-4. - PMID 20819586 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Although thrombolytic therapy with rescue percutaneous coronary intervention (PCI) is a common treatment strategy for ST-segment elevation acute myocardial infarction (STEMI), scant data are available on its efficacy relative to primary PCI, and comparison was therefore the aim of this study | ||
| 520 | |a METHODS: This multicenter, open-label, randomized, parallel trial was conducted in 12 hospitals on patients (age < or = 70 years) with STEMI who presented within 12 hours of symptom onset (mean interval > 3 hours). Patients were randomized to three groups: primary PCI group (n = 101); recombinant staphylokinase (r-Sak) group (n = 104); and recombinant tissue-type plasminogen activator (rt-PA) group (n = 106). For all patients allocated to the thrombolytic therapy arm, coronary angiography was performed at 90 minutes after drug therapy to confirm infarct-related artery (IRA) patency; rescue PCI was performed in cases with TIMI flow grade < or = 2. Bare-metal stent implantation was planned for all patients | ||
| 520 | |a RESULTS: After randomization it required an average of 113.4 minutes to start thrombolytic therapy (door-to-needle time) and 141.2 minutes to perform first balloon inflation in the IRA (door to balloon time). Rates of IRA patency (TIMI flow grade 2 or 3) and TIMI flow grade 3 were significantly lower in the thrombolysis group at 90 minutes after drug therapy than in the primary PCI group at the end of the procedure (70.5% vs. 98.0%, P < 0.0001, and 53.0% vs. 85.9%, P < 0.0001, respectively). Rescue PCI with stenting was performed in 117 patients (55.7%) in the thrombolytic therapy arm. Rates of patency and TIMI flow grade 3 were still significantly lower in the rescue PCI than in the primary PCI group (88.9% vs. 97.9%, P = 0.0222, and 68.4% vs. 85.0%, P = 0.0190, respectively). At 30 days post-therapy, mortality rate was significantly higher in the thrombolysis combined with rescue PCI group than in primary PCI group (7.1% vs. 0, P = 0.0034). Rates of death/MI and bleeding complications were significantly higher in the thrombolysis with rescue PCI group than in the primary PCI group (10.0% vs. 1.0%, P = 0.0380, and 28.10% vs. 8.91%, P = 0.0001, respectively) | ||
| 520 | |a CONCLUSIONS: Thrombolytic therapy with rescue PCI was associated with significantly lower rates of coronary patency and TIMI flow grade 3, but with significantly higher rates of mortality, death/MI and hemorrhagic complications at 30 days, as compared with primary PCI in this group of Chinese STEMI patients with late presentation and delayed treatments | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 7 | |a Fibrinolytic Agents |2 NLM | |
| 700 | 1 | |a Han, Ya-ling |e verfasserin |4 aut | |
| 700 | 1 | |a Yang, Xin-chun |e verfasserin |4 aut | |
| 700 | 1 | |a Mao, Jie-ming |e verfasserin |4 aut | |
| 700 | 1 | |a Fang, Wei-yi |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Lei |e verfasserin |4 aut | |
| 700 | 1 | |a Shen, Wei-feng |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Zhan-quan |e verfasserin |4 aut | |
| 700 | 1 | |a Jia, Guo-liang |e verfasserin |4 aut | |
| 700 | 1 | |a Lü, Shu-zheng |e verfasserin |4 aut | |
| 700 | 1 | |a Wei, Meng |e verfasserin |4 aut | |
| 700 | 1 | |a Zeng, Ding-yin |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Ji-lin |e verfasserin |4 aut | |
| 700 | 1 | |a Qin, Xue-wen |e verfasserin |4 aut | |
| 700 | 1 | |a Xu, Bo |e verfasserin |4 aut | |
| 700 | 1 | |a DU, Chang-hui |e verfasserin |4 aut | |
| 700 | 0 | |a Collaborative Research Group of Reperfusion Therapy in Acute Myocardial Infarction (RESTART) |e verfasserin |4 aut | |
| 700 | 1 | |a Fang, Qi |e investigator |4 oth | |
| 700 | 1 | |a Chen, Zai-jia |e investigator |4 oth | |
| 700 | 1 | |a Gao, Run-lin |e investigator |4 oth | |
| 700 | 1 | |a Chen, Ji-lin |e investigator |4 oth | |
| 700 | 1 | |a Gao, Run-lin |e investigator |4 oth | |
| 700 | 1 | |a Chen, Ji-lin |e investigator |4 oth | |
| 700 | 1 | |a Shen, Wei-feng |e investigator |4 oth | |
| 700 | 1 | |a Mao, Jie-ming |e investigator |4 oth | |
| 700 | 1 | |a Yang, Xin-chun |e investigator |4 oth | |
| 700 | 1 | |a Ni, Zong-zan |e investigator |4 oth | |
| 700 | 1 | |a Fang, Qi |e investigator |4 oth | |
| 700 | 1 | |a Chen, Zai-jia |e investigator |4 oth | |
| 700 | 1 | |a Gao, Run-lin |e investigator |4 oth | |
| 700 | 1 | |a Chen, Ji-lin |e investigator |4 oth | |
| 700 | 1 | |a Gao, Run-lin |e investigator |4 oth | |
| 700 | 1 | |a Chen, Ji-lin |e investigator |4 oth | |
| 700 | 1 | |a Shen, Wei-feng |e investigator |4 oth | |
| 700 | 1 | |a Mao, Jie-ming |e investigator |4 oth | |
| 700 | 1 | |a Yang, Xin-chun |e investigator |4 oth | |
| 700 | 1 | |a Ni, Zong-zan |e investigator |4 oth | |
| 700 | 1 | |a Du, Chang-hui |e investigator |4 oth | |
| 700 | 1 | |a Xu, Bo |e investigator |4 oth | |
| 700 | 1 | |a Li, Chong-jian |e investigator |4 oth | |
| 700 | 1 | |a Han, Ya-ling |e investigator |4 oth | |
| 700 | 1 | |a Yang, Xin-chun |e investigator |4 oth | |
| 700 | 1 | |a Gao, Run-lin |e investigator |4 oth | |
| 700 | 1 | |a Fang, Wei-yi |e investigator |4 oth | |
| 700 | 1 | |a Wang, Lei |e investigator |4 oth | |
| 700 | 1 | |a Shen, Wei-feng |e investigator |4 oth | |
| 700 | 1 | |a Li, Zhan-quan |e investigator |4 oth | |
| 700 | 1 | |a Jia, Guo-liang |e investigator |4 oth | |
| 700 | 1 | |a Lü, Shu-zheng |e investigator |4 oth | |
| 700 | 1 | |a Wei, Meng |e investigator |4 oth | |
| 700 | 1 | |a Deng, Ding-yi |e investigator |4 oth | |
| 700 | 1 | |a Qin, Xue-wen |e investigator |4 oth | |
| 700 | 1 | |a Yang, Yue-jin |e investigator |4 oth | |
| 700 | 1 | |a Qiao, Shu-bin |e investigator |4 oth | |
| 700 | 1 | |a Yao, Min |e investigator |4 oth | |
| 700 | 1 | |a Liu, Hai-bo |e investigator |4 oth | |
| 700 | 1 | |a Wu, Yong-jian |e investigator |4 oth | |
| 700 | 1 | |a Yuan, Jin-qing |e investigator |4 oth | |
| 700 | 1 | |a Chen, Jue |e investigator |4 oth | |
| 700 | 1 | |a Wu, Yuan |e investigator |4 oth | |
| 700 | 1 | |a Huang, Kun |e investigator |4 oth | |
| 700 | 1 | |a Shi, Jin-fa |e investigator |4 oth | |
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