Chemotherapy Research Today is a free monthly online journal that collates and summarizes the latest research about Chemotherapy, including details on cancer treatment, side effects, drugs. | ||||||||
|
Comparison of very early treatment with either fibrinolysis or percutaneous coronary intervention facilitated with abciximab with respect to ST recovery and infarct-related artery epicardial flow in patients with acute ST-segment elevation myocardial infarction: the Swedish Early Decision (SWEDES) reperfusion trial.Svensson L, Aasa M, Dellborg M, Gibson CM, Kirtane A, Herlitz J, Ohlsson A, Karlsson T, Grip L Stockholm South Hospital, Stockholm, Sweden. leif.svensson@sodersjukhuset.se BACKGROUND: Results from a number of studies indicate that primary percutaneous coronary intervention (PCI) is superior to fibrinolysis for treatment of acute ST-elevation myocardial infarction. Modern adjunctive antithrombotic treatment with systematic use of low-molecular-weight heparins, fibrin-specific thrombolysis, and glycoprotein IIb/IIIa receptor inhibitors may improve the outcome compared with what was achieved in previous studies. METHODS: Patients with ST-elevation myocardial infarction were randomized to receive enoxaparin followed by reteplase (group A; n = 104) or enoxaparin followed by abciximab and transfer to invasive center for optional PCI (group B; n = 101). Primary end points were ST-segment resolution 120 minutes and TIMI flow at coronary angiography 5 to 7 days after randomization. RESULTS: Forty-two percent of the patients started therapy in the prehospital phase. Time from symptom to treatment was 114 minutes in group A and 202 minutes in group B. Baseline characteristics were similar in the 2 groups. Sixty-four percent in group A and 68% in group B had ST resolution of > 50% at 120 minutes (not significant). At control angiography, 54% in the fibrinolytic group and 71% in the invasive group had TIMI 3 flow (P = .04). At 30 days, the composite of death, stroke, or reinfarction occurred in 8% in the fibrinolytic group compared with 3% in the invasive group (not significant). CONCLUSIONS: Despite much shorter time delay to start of fibrinolysis than PCI, this did not result in signs of superior myocardial reperfusion. Epicardial flow in the infarct-related artery was better after invasive therapy, and there was a trend toward better clinical outcome after this treatment compared with after fibrinolysis. Published 29 March 2006 in Am Heart J, 151(4): 798.e1-7.
© 2004-2012 Chemotherapy Research Today. All Rights Reserved. |
| ||||||
