ST-segment recovery and prognosis in patients with ST-elevation myocardial infarction reperfused by prehospital combination fibrinolysis, prehospital initiated facilitated percutaneous coronary intervention, or primary percutaneous coronary intervention.
Complete ST-segment recovery (STR) is associated with favorable prognosis in ST-elevation myocardial infarction (STEMI). The optimal reperfusion strategy in patients presenting soon after symptom onset is still a matter of debate. STR for patients treated by prehospital combination fibrinolysis or prehospital initiated facilitated percutaneous coronary intervention (PCI) compared with primary PCI has not been assessed. In the Leipzig Prehospital Fibrinolysis Study, patients with STEMI (symptoms <6 hours) were randomized to prehospital combination fibrinolysis (1/2 dose reteplase + abciximab; n = 82, group A) or prehospital initiated facilitated PCI (n = 82, group B). Further, a control group of patients with primary PCI (n = 136, group C) was prospectively assessed. STR at 90 minutes was analyzed by blinded observers as percent resolution. Categorization was performed as complete resolution (>70%), intermediate resolution (70% to 30%), or no resolution (<30%). The percentage of patients with complete STR was highest in group B with 80% versus 52% in group A and 52% in group C (p <0.001, B vs A and C, p = NS; A vs C). Complete STR resulted in lower event rates for the combined clinical end point of death, myocardial reinfarction, and stroke compared with intermediate and no STR in groups A (complete 9.8%, intermediate 23.8%, no STR 36.8%, p = 0.04), B (7.7%, 18.2%, and 50.0%, p = 0.01), and C (8.6%, 18.4%, and 42.9%, p <0.001). In conclusion, prehospital initiated facilitated PCI results in the highest percentage of complete STR compared with prehospital combination fibrinolysis or primary PCI. In addition, STR has been confirmed to predict prognosis in timely optimized reperfusion strategies.
Thiele
Holger
H
Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany. thielh@medizin.uni-leipzig.de
Scholz
Marius
M
Engelmann
Lothar
L
Storch
Wulf-Hinrich
WH
Hartmann
Andreas
A
Dimmel
Gerald
G
Pfeiffer
Dietrich
D
Schuler
Gerhard
G
D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005858:Germany; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011379:Prognosis; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D005343:Fibrinolytic Agents; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; C087896:reteplase; D010959:Tissue Plasminogen Activator; D000077284:Abciximab