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Benefit of facilitated percutaneous coronary intervention in high-risk ST-segment elevation myocardial infarction patients presenting to nonpercutaneous coronary intervention hospitals.

Publication ,  Journal Article
Herrmann, HC; Lu, J; Brodie, BR; Armstrong, PW; Montalescot, G; Betriu, A; Neuman, F-J; Effron, MB; Barnathan, ES; Topol, EJ; Ellis, SG ...
Published in: JACC Cardiovasc Interv
October 2009

OBJECTIVES: We hypothesized that patients most likely to benefit would be those at high risk with a shorter duration of acute ischemia and who required transfer for percutaneous coronary intervention (PCI). BACKGROUND: The FINESSE (Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events) study failed to demonstrate an improvement in the 90-day composite clinical end point of early treatment with abciximab plus half-dose reteplase (combination-facilitated PCI) or abciximab alone. METHODS: We performed a retrospective analysis of 2,452 patients in this double-blind, placebo-controlled study. Patients were stratified by Thrombolysis In Myocardial Infarction (TIMI) risk score for ST-segment elevation myocardial infarction (STEMI), presentation to a spoke (no PCI available) or hub site, and symptom-to-randomization time. Outcomes included the primary composite end point of death, ventricular fibrillation after 48 h, cardiogenic shock, and congestive heart failure through day 90 as well as 1-year mortality. RESULTS: Mortality for all patients at 1 year was directly related to TIMI risk score (23 of 1,223 = 1.9% in patients with score <3 and 145 of 1,229 = 11.8% with score > or =3, p < 0.001). Patients with TIMI risk score > or =3 and presentation to a spoke site with a symptom-to-randomization time < or =4 h had significantly better 1-year survival if treated with combination-facilitated PCI (hazard ratio [HR]: 0.351, p = 0.01) as well as 90-day composite outcome (HR: 0.45, p = 0.009). A trend for improved survival was also observed in patients with TIMI score > or =3 and spoke site alone (HR: 0.549, p = 0.06). CONCLUSIONS: Facilitation of PCI with a combination of abciximab and half-dose reteplase improved survival at 1 year in high-risk patients presenting to a spoke hospital with symptom-to-randomization time < or =4 h. Further prospective study of facilitated PCI in this subgroup of patients is warranted.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

October 2009

Volume

2

Issue

10

Start / End Page

917 / 924

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Time Factors
  • Thrombolytic Therapy
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Recombinant Proteins
  • Randomized Controlled Trials as Topic
  • Platelet Aggregation Inhibitors
 

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Herrmann, H. C., Lu, J., Brodie, B. R., Armstrong, P. W., Montalescot, G., Betriu, A., … FINESSE Investigators, . (2009). Benefit of facilitated percutaneous coronary intervention in high-risk ST-segment elevation myocardial infarction patients presenting to nonpercutaneous coronary intervention hospitals. JACC Cardiovasc Interv, 2(10), 917–924. https://doi.org/10.1016/j.jcin.2009.06.018
Herrmann, Howard C., Jiandong Lu, Bruce R. Brodie, Paul W. Armstrong, Gilles Montalescot, Amadeo Betriu, Franz-Joseph Neuman, et al. “Benefit of facilitated percutaneous coronary intervention in high-risk ST-segment elevation myocardial infarction patients presenting to nonpercutaneous coronary intervention hospitals.JACC Cardiovasc Interv 2, no. 10 (October 2009): 917–24. https://doi.org/10.1016/j.jcin.2009.06.018.
Herrmann HC, Lu J, Brodie BR, Armstrong PW, Montalescot G, Betriu A, et al. Benefit of facilitated percutaneous coronary intervention in high-risk ST-segment elevation myocardial infarction patients presenting to nonpercutaneous coronary intervention hospitals. JACC Cardiovasc Interv. 2009 Oct;2(10):917–24.
Herrmann, Howard C., et al. “Benefit of facilitated percutaneous coronary intervention in high-risk ST-segment elevation myocardial infarction patients presenting to nonpercutaneous coronary intervention hospitals.JACC Cardiovasc Interv, vol. 2, no. 10, Oct. 2009, pp. 917–24. Pubmed, doi:10.1016/j.jcin.2009.06.018.
Herrmann HC, Lu J, Brodie BR, Armstrong PW, Montalescot G, Betriu A, Neuman F-J, Effron MB, Barnathan ES, Topol EJ, Ellis SG, FINESSE Investigators. Benefit of facilitated percutaneous coronary intervention in high-risk ST-segment elevation myocardial infarction patients presenting to nonpercutaneous coronary intervention hospitals. JACC Cardiovasc Interv. 2009 Oct;2(10):917–924.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

October 2009

Volume

2

Issue

10

Start / End Page

917 / 924

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Time Factors
  • Thrombolytic Therapy
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Recombinant Proteins
  • Randomized Controlled Trials as Topic
  • Platelet Aggregation Inhibitors