PMID- 14605015 OWN - NLM STAT- MEDLINE DCOM- 20031120 LR - 20181130 IS - 1524-4539 (Electronic) IS - 0009-7322 (Linking) VI - 108 IP - 16 Suppl 1 DP - 2003 Oct 21 TI - Prospective evaluation of clinical outcomes after acute ST-elevation myocardial infarction in patients who are ineligible for reperfusion therapy: preliminary results from the TETAMI registry and randomized trial. PG - III14-21 AB - BACKGROUND: Treatment with lytics or primary percutaneous coronary interventions (PCI) reduces the mortality rate of patients with ST-elevation myocardial infarction (STEMI) presenting within 12 hours. Patients presenting >12 hours are generally considered to be ineligible for reperfusion therapy, and there are currently no specific treatment recommendations for this subgroup.Methods- All patients with STEMI <24 hours were included in the Treatment with Enoxaparin and Tirofiban in Acute Myocardial Infarction (TETAMI) randomized trial or registry. Those patients who were ineligible for acute reperfusion, had no cardiogenic shock, and were not planned for revascularization within 48 hours were randomized to 1 of 4 antithrombotic regimens involving enoxaparin or unfractionated heparin (UFH), in combination with tirofiban or placebo for 2 to 8 days. A concurrent registry tracked STEMI patients coming in within <12 hours, and who underwent reperfusion. This registry also tracked the remaining STEMI patients who neither received reperfusion nor were enrolled in the TETAMI randomized trial. The demographics and clinical outcomes of all three groups (received reperfusion therapy, too late for reperfusion and enrolled in the randomized trial, neither received reperfusion therapy nor were enrolled in the randomized trial) were prospectively tracked. RESULTS AND CONCLUSIONS: There were 2,737 patients who presented with STEMI or a new left branch bundle block (LBBB), of which 1,654 (60%) presented < or =12 hours. There were 1,196 (72%) of 1,654 patients who received reperfusion therapy. There were 458 (28%) of the 1,654 patients deemed "ineligible" for reperfusion, mostly because of a contraindication to lytics or for being "too old." In contrast, 1,083 (40%) of 2,737 patients presented >12 hours. Apart from 34 of these patients who had a stuttering infarction and were referred for reperfusion, the remaining patients did not receive reperfusion therapy. Registry patients who received reperfusion therapy, compared with TETAMI randomized patients (all of whom received antithrombotic therapy) and registry patients who did not receive reperfusion, were younger (61 years versus 63 years and 67 years), were more likely to be male (78% versus 73% and 63%), and had persistent ST-segment elevation as opposed to LBBB or Q waves. Registry patients who received reperfusion therapy had better clinical outcomes, even after adjusting for admission Killip class, compared with TETAMI randomized patients and registry patients who did not receive reperfusion therapy. TETAMI randomized patients had better outcomes than registry patients who did not receive reperfusion therapy. The major obstacle to expanding the delivery of reperfusion therapy to patients with STEMI is the large fraction of patients who present too late for reperfusion therapy. Examination of prospectively gathered data on STEMI patients who are ineligible for reperfusion may help optimize their treatment. FAU - Cohen, Marc AU - Cohen M AD - Cardiac Cath Lab Administration, Newark Beth Israel Medical Center, Newark, NJ 07112, USA. marcohen@sbhcs.com FAU - Gensini, Gian Franco AU - Gensini GF FAU - Maritz, Frans AU - Maritz F FAU - Gurfinkel, Enrique P AU - Gurfinkel EP FAU - Huber, Kurt AU - Huber K FAU - Timerman, Ari AU - Timerman A FAU - Krzeminska-Pakula, Maria AU - Krzeminska-Pakula M FAU - Santopinto, Jose AU - Santopinto J FAU - Hecquet, Carole AU - Hecquet C FAU - Vittori, Luc AU - Vittori L CN - TETAMI Investigators LA - eng PT - Clinical Trial PT - Comparative Study PT - Journal Article PT - Multicenter Study PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - Circulation JT - Circulation JID - 0147763 RN - 0 (Anticoagulants) RN - 0 (Enoxaparin) RN - 0 (Fibrinolytic Agents) RN - 0 (Platelet Aggregation Inhibitors) RN - 42HK56048U (Tyrosine) RN - 9005-49-6 (Heparin) RN - GGX234SI5H (Tirofiban) SB - IM MH - Age Factors MH - Aged MH - Anticoagulants/therapeutic use MH - Bundle-Branch Block/etiology MH - Double-Blind Method MH - Drug Therapy, Combination MH - Electrocardiography MH - Enoxaparin/*therapeutic use MH - Female MH - Fibrinolytic Agents/therapeutic use MH - Heparin/therapeutic use MH - Humans MH - Male MH - Middle Aged MH - Myocardial Infarction/complications/diagnosis/*drug therapy MH - *Myocardial Reperfusion/statistics & numerical data MH - Platelet Aggregation Inhibitors/therapeutic use MH - Prospective Studies MH - Registries/*statistics & numerical data MH - Survival Rate MH - Tirofiban MH - Treatment Outcome MH - Tyrosine/*analogs & derivatives/*therapeutic use EDAT- 2003/11/08 05:00 MHDA- 2003/12/03 05:00 CRDT- 2003/11/08 05:00 PHST- 2003/11/08 05:00 [pubmed] PHST- 2003/12/03 05:00 [medline] PHST- 2003/11/08 05:00 [entrez] AID - 108/16_suppl_1/III-14 [pii] AID - 10.1161/01.CIR.0000091832.74006.1C [doi] PST - ppublish SO - Circulation. 2003 Oct 21;108(16 Suppl 1):III14-21. doi: 10.1161/01.CIR.0000091832.74006.1C.