PMID- 25108302
OWN - NLM
STAT- MEDLINE
DCOM- 20141113
LR  - 20161125
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 114
IP  - 6
DP  - 2014 Sep 15
TI  - Outcomes of a pharmacoinvasive strategy for successful versus failed fibrinolysis 
      and primary percutaneous intervention in acute myocardial infarction (from the 
      STrategic Reperfusion Early After Myocardial Infarction [STREAM] study).
PG  - 811-9
LID - S0002-9149(14)01358-7 [pii]
LID - 10.1016/j.amjcard.2014.06.011 [doi]
AB  - Although a fibrinolytic pharmacoinvasive strategy is recommended for patients 
      with ST elevation myocardial infarction (STEMI) unable to undergo timely primary 
      percutaneous coronary intervention (PCI), there are limited data addressing 
      outcomes specific to those with successful or unsuccessful pharmacologic 
      reperfusions. Accordingly, we evaluated a contemporary pharmacoinvasive strategy 
      for failed and successful reperfusions within the STrategic Reperfusion Early 
      After Myocardial infarction study. Of 1,823 per-protocol-treated patients with 
      STEMI, we examined clinical outcomes and angiographic and electrocardiographic 
      metrics in 3 groups as follows: fibrinolysis requiring rescue (rescue, n = 348), 
      fibrinolysis with scheduled angiography (scheduled, n = 516), and primary PCI (n 
      = 927). Compared with pharmacoinvasive patients undergoing scheduled angiography, 
      rescue patients were more likely to have anterior wall myocardial infarction, 
      more baseline ST-segment elevation and deviation, as well as Q waves in the 
      distribution of their ST elevation. Residual ST elevation >/= 2 mm 30 minutes after 
      angiography occurred in 27.9%, 7.9%, and 24.8% of patients who underwent rescue, 
      scheduled, and primary PCI, respectively. Thirty-day composite event rates 
      (all-cause death, cardiogenic shock, heart failure, and reinfarction) were 18.7%, 
      5.5%, and 13.9%; all-cause death: 6.1%, 2.1%, and 3.9%; cardiogenic shock: 7.5%, 
      2.0%, and 5.4%; heart failure: 11.8%, 2.3%, and 7.6%; and reinfarction: 1.5%, 
      1.4%, and 2.2%, for rescue, scheduled, and primary PCI, respectively. Compared 
      with successfully reperfused patients undergoing scheduled angiography, the 
      adjusted relative risk of the primary outcome was 2.92 (95% confidence interval 
      1.92 to 4.45) in rescue patients. In conclusion, pharmacoinvasive-treated 
      patients requiring rescue angiography had greater baseline risk with more 
      co-morbidities and worse 30-day outcomes compared with successful 
      fibrinolytic-treated patients. Residual ST elevation after reperfusion assists in 
      defining prognosis.
CI  - Copyright (c) 2014 Elsevier Inc. All rights reserved.
FAU - Welsh, Robert C
AU  - Welsh RC
AD  - Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, 
      Alberta, Canada.
FAU - Van de Werf, Frans
AU  - Van de Werf F
AD  - Department of Cardiovascular Sciences, University Hospital Gasthuisberg, Leuven, 
      Belgium.
FAU - Westerhout, Cynthia M
AU  - Westerhout CM
AD  - Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, 
      Alberta, Canada.
FAU - Goldstein, Patrick
AU  - Goldstein P
AD  - Department and Service d'aide Medicale Urgente, Lille University Hospital, Lille 
      Cedex, France.
FAU - Gershlick, Anthony H
AU  - Gershlick AH
AD  - Leicester Cardiovascular Biomedical Research Unit, University Hospital of 
      Leicester, Leicester, United Kingdom.
FAU - Wilcox, Robert G
AU  - Wilcox RG
AD  - Department of Cardiovascular Medicine, Nottingham University Hospital, 
      Nottingham, United Kingdom.
FAU - Danays, Thierry
AU  - Danays T
AD  - Boehringer Ingelheim, Reims, France.
FAU - Bluhmki, Erich
AU  - Bluhmki E
AD  - Boehringer Ingelheim, Biberach, Germany.
FAU - Lopes, Renato D
AU  - Lopes RD
AD  - Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil; Duke 
      Clinical Research Institute, Durham, North Carolina.
FAU - Steg, Philippe Gabriel
AU  - Steg PG
AD  - Department of Cardiology, Hopital Bichat, INSERM U698 and Universite 
      Paris-Diderot, Paris, France.
FAU - Armstrong, Paul W
AU  - Armstrong PW
AD  - Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, 
      Alberta, Canada. Electronic address: paul.armstrong@ualberta.ca.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
DEP - 20140708
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Aged
MH  - Coronary Angiography
MH  - Drug Therapy, Combination
MH  - *Electrocardiography
MH  - Female
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnostic imaging/*therapy
MH  - Percutaneous Coronary Intervention/*methods
MH  - Platelet Aggregation Inhibitors/*therapeutic use
MH  - Thrombolytic Therapy/*methods
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2014/08/12 06:00
MHDA- 2014/11/14 06:00
CRDT- 2014/08/11 06:00
PHST- 2014/04/28 00:00 [received]
PHST- 2014/06/21 00:00 [revised]
PHST- 2014/06/21 00:00 [accepted]
PHST- 2014/08/11 06:00 [entrez]
PHST- 2014/08/12 06:00 [pubmed]
PHST- 2014/11/14 06:00 [medline]
AID - S0002-9149(14)01358-7 [pii]
AID - 10.1016/j.amjcard.2014.06.011 [doi]
PST - ppublish
SO  - Am J Cardiol. 2014 Sep 15;114(6):811-9. doi: 10.1016/j.amjcard.2014.06.011. Epub 
      2014 Jul 8.