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Adverse outcomes in fibrinolytic-based facilitated percutaneous coronary intervention: insights from the ASSENT-4 PCI electrocardiographic substudy.

Publication ,  Journal Article
McDonald, MA; Fu, Y; Zeymer, U; Wagner, G; Goodman, SG; Ross, A; Granger, CB; Van de Werf, F; Armstrong, PW; ASSENT-4 PCI Investigators,
Published in: Eur Heart J
April 2008

AIMS: Patients in ASSENT-4 PCI undergoing tenecteplase-facilitated percutaneous coronary intervention (PCI) had more adverse events than those undergoing primary PCI. We analysed this to gain further insights. METHODS AND RESULTS: A total of 549 patients with facilitated PCI and 541 undergoing primary PCI were characterized according to the extent of ST resolution. We also examined the relationship between time from symptom onset, presence of baseline Q waves, and 90 day events. Irrespective of treatment, 90 day mortality was lowest among 186 patients with complete ST resolution at both 60 and 180 min (1.8% facilitated; 0% primary PCI group) and highest in those 502 patients without complete ST resolution at either 60 or 180 min (6.7% facilitated; 5.2% primary PCI group, all P < or = 0.05). Patients undergoing facilitated PCI presenting >3 h with baseline Q waves also had higher 90 day mortality compared with those without Q waves (10.4 vs. 2.5%, P = 0.056). No significant differences were found within primary PCI patients on the basis of time from symptom onset or presence of initial Q waves. CONCLUSION: In this post hoc analysis, our data suggest that a fibrinolysis-facilitated PCI strategy was especially harmful in patients presenting beyond 3 h from symptom onset with established Q waves on their baseline ECG. This may relate to the convergence of later, less effective pre-procedural reperfusion but persisting exposure to the pro-thrombotic and bleeding risks of fibrinolysis.

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Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

April 2008

Volume

29

Issue

7

Start / End Page

871 / 879

Location

England

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Tenecteplase
  • Prognosis
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Fibrinolytic Agents
 

Citation

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McDonald, M. A., Fu, Y., Zeymer, U., Wagner, G., Goodman, S. G., Ross, A., … ASSENT-4 PCI Investigators, . (2008). Adverse outcomes in fibrinolytic-based facilitated percutaneous coronary intervention: insights from the ASSENT-4 PCI electrocardiographic substudy. Eur Heart J, 29(7), 871–879. https://doi.org/10.1093/eurheartj/ehn078
McDonald, Michael A., Yuling Fu, Uwe Zeymer, Galen Wagner, Shaun G. Goodman, Allan Ross, Christopher B. Granger, Frans Van de Werf, Paul W. Armstrong, and Paul W. ASSENT-4 PCI Investigators. “Adverse outcomes in fibrinolytic-based facilitated percutaneous coronary intervention: insights from the ASSENT-4 PCI electrocardiographic substudy.Eur Heart J 29, no. 7 (April 2008): 871–79. https://doi.org/10.1093/eurheartj/ehn078.
McDonald MA, Fu Y, Zeymer U, Wagner G, Goodman SG, Ross A, et al. Adverse outcomes in fibrinolytic-based facilitated percutaneous coronary intervention: insights from the ASSENT-4 PCI electrocardiographic substudy. Eur Heart J. 2008 Apr;29(7):871–9.
McDonald, Michael A., et al. “Adverse outcomes in fibrinolytic-based facilitated percutaneous coronary intervention: insights from the ASSENT-4 PCI electrocardiographic substudy.Eur Heart J, vol. 29, no. 7, Apr. 2008, pp. 871–79. Pubmed, doi:10.1093/eurheartj/ehn078.
McDonald MA, Fu Y, Zeymer U, Wagner G, Goodman SG, Ross A, Granger CB, Van de Werf F, Armstrong PW, ASSENT-4 PCI Investigators. Adverse outcomes in fibrinolytic-based facilitated percutaneous coronary intervention: insights from the ASSENT-4 PCI electrocardiographic substudy. Eur Heart J. 2008 Apr;29(7):871–879.
Journal cover image

Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

April 2008

Volume

29

Issue

7

Start / End Page

871 / 879

Location

England

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Tenecteplase
  • Prognosis
  • Myocardial Reperfusion
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Humans
  • Fibrinolytic Agents