A comparison of outcomes of routine early angiography versus delayed ischemia-guided angiography after thrombolytic therapy in ST segment-elevation myocardial infarction

Basiri, H.A. and Kiani, R. and Abdi, S. and Zahedmehr, A. and Sanati, H.R. and Shakerian, F. and Firoozi, A. (2011) A comparison of outcomes of routine early angiography versus delayed ischemia-guided angiography after thrombolytic therapy in ST segment-elevation myocardial infarction. Iranian Cardiovascular Research Journal, 5 (2). pp. 56-60.

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Background: Thrombolytic therapy continues to be the common treatment in acute ST elevation myocardial infarction in the majority of heart centers worldwide. However, thrombolytic therapy is associated with high re-occlusion and re-infarction rates. So, most patients now undergo early diagnostic angiography and possibly angioplasty of the culprit artery but the controversy about the timing of angiography after thrombolysis continues to remain unresolved. In this prospective cohort study, we compared the outcome of early invasive strategy versus delayed invasive approach in ST-elevation MI patients who had received successful thrombolytic therapy. Primary endpoint of the study was Major Adverse Cardiovascular Events or MACE (the combined rate of death, re-infarction, major bleeding and cerebrovasular events. Secondary endpoints were re-infarction and re-hospitalization rate. Method: The study comprised 142 patients of which 87 had a routine angiography in less than 10 days of acute event and 55 underwent ischemia-guided angiography after 10 days of index event. Stenting of the culprit vessel was done in 60 of the routine angiography group and 63 of the ischemia-guided group. The patients were followed for 8.8 ± 2.8 months after the index event. Results: The primary endpoint occurred in 6.9 of routine angiography patients and 10.9 of the control group (P= 0.4). The rate of re-infarction was significantly higher in the delayed invasive arm than routine early invasive arm (10.9 vs. 1.1, P:0.01),and mostly occurring before angiography. Conclusion: routine angiography as soon as possible after thrombolysis can reduce re-infarction and was not associated with any increased risk of adverse events in our study.

Item Type: Article
Additional Information: cited By 0
Uncontrolled Keywords: acetylsalicylic acid; clopidogrel; fibrinolytic agent; streptokinase, adult; aged; angiocardiography; article; bleeding; cerebrovascular accident; cohort analysis; controlled study; coronary artery bypass graft; female; fibrinolytic therapy; heart muscle ischemia; heart muscle revascularization; hospitalization; human; intermethod comparison; loading drug dose; major clinical study; male; mortality; percutaneous coronary intervention; recurrent disease; ST segment elevation myocardial infarction; stent; treatment outcome; angiography; bleeding; cardiovascular risk; cerebrovascular accident; coronary blood vessel; coronary stent; death; delayed diagnosis; diabetes mellitus; dyslipidemia; early diagnosis; heart death; heart reinfarction; hypertension; outcome assessment; prospective study; smoking; ST segment elevation myocardial infarction; therapy delay
Subjects: WG Cardiovascular System
Depositing User: somayeh pourmorteza
Date Deposited: 05 Jan 2019 10:49
Last Modified: 05 Jan 2019 10:49
URI: http://eprints.iums.ac.ir/id/eprint/7397

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