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Very Early Versus Early Percutaneous Coronary Intervention After Successful Fibrinolytic Therapy in Pharmacoinvasive Strategy.
Glob Heart 2018; 13(4):261-265GH

Abstract

BACKGROUND

The proper time for the use of percutaneous coronary intervention (PCI) following the successful fibrinolysis for ST-segment elevation myocardial infarction (STEMI) for maximum efficiency and minimum side effects has not been determined yet. The present study was designed to compare the outcome of myocardial infarction patients who received fibrinolytic therapy with successful results and underwent PCI very early (within 3-12 h) (group 1) versus early (within 12-24 h) (group 2).

METHODS

The study compared the occurrence of major adverse cardiac events during PCI (no-reflow phenomenon, access site bleeding, cerebral hemorrhage, and cardiac death). Patients were followed for 6 months after PCI for the occurrence of unstable angina, recurrent angina, non-STEMI, recurrent STEMI, repeat revascularization, heart failure, and cardiac death.

RESULTS

Group 1 (121 patients) with the mean age of 59.93 ± 10.43 years were compared with group 2 (144 patients) with the mean age of 62.84 ± 10.22 years. Except for age, the 2 groups were not significantly different regarding baseline characteristics. No-reflow phenomenon was less in group 1 with p value = 0.005, whereas incidence of access site bleeding and cerebral hemorrhage were more in this group with p value = 0.001 and 0.049, respectively. During the period of 6 months' follow-up, recurrent angina and recurrent non-STEMI occurred more in group 2 with p value = 0.049 and 0.035, respectively, with no other significant difference between the 2 groups.

CONCLUSIONS

No-reflow phenomenon and the risk of recurrent ischemia is significantly lower in patients undergoing PCI very early after successful fibrinolytic therapy, but the risk of bleeding is increased in this time. So it is recommended that patients received successful fibrinolytic therapy to be subjected to very early PCI within 3 to 12 h from fibrinolysis.

Authors+Show Affiliations

Cardiovascular Department, Tanta University, Tanta, Egypt. Electronic address: khalfallah@yahoo.com.Cardiovascular Department, Tanta University, Tanta, Egypt.Cardiovascular Department, Tanta University, Tanta, Egypt.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30098929

Citation

Khalfallah, Mohamed, et al. "Very Early Versus Early Percutaneous Coronary Intervention After Successful Fibrinolytic Therapy in Pharmacoinvasive Strategy." Global Heart, vol. 13, no. 4, 2018, pp. 261-265.
Khalfallah M, Elsheikh A, Abdalaal M. Very Early Versus Early Percutaneous Coronary Intervention After Successful Fibrinolytic Therapy in Pharmacoinvasive Strategy. Glob Heart. 2018;13(4):261-265.
Khalfallah, M., Elsheikh, A., & Abdalaal, M. (2018). Very Early Versus Early Percutaneous Coronary Intervention After Successful Fibrinolytic Therapy in Pharmacoinvasive Strategy. Global Heart, 13(4), pp. 261-265. doi:10.1016/j.gheart.2018.06.003.
Khalfallah M, Elsheikh A, Abdalaal M. Very Early Versus Early Percutaneous Coronary Intervention After Successful Fibrinolytic Therapy in Pharmacoinvasive Strategy. Glob Heart. 2018;13(4):261-265. PubMed PMID: 30098929.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Very Early Versus Early Percutaneous Coronary Intervention After Successful Fibrinolytic Therapy in Pharmacoinvasive Strategy. AU - Khalfallah,Mohamed, AU - Elsheikh,Ayman, AU - Abdalaal,Mohamed, Y1 - 2018/08/08/ PY - 2018/01/26/received PY - 2018/05/17/revised PY - 2018/06/29/accepted PY - 2018/8/14/pubmed PY - 2019/1/17/medline PY - 2018/8/13/entrez SP - 261 EP - 265 JF - Global heart JO - Glob Heart VL - 13 IS - 4 N2 - BACKGROUND: The proper time for the use of percutaneous coronary intervention (PCI) following the successful fibrinolysis for ST-segment elevation myocardial infarction (STEMI) for maximum efficiency and minimum side effects has not been determined yet. The present study was designed to compare the outcome of myocardial infarction patients who received fibrinolytic therapy with successful results and underwent PCI very early (within 3-12 h) (group 1) versus early (within 12-24 h) (group 2). METHODS: The study compared the occurrence of major adverse cardiac events during PCI (no-reflow phenomenon, access site bleeding, cerebral hemorrhage, and cardiac death). Patients were followed for 6 months after PCI for the occurrence of unstable angina, recurrent angina, non-STEMI, recurrent STEMI, repeat revascularization, heart failure, and cardiac death. RESULTS: Group 1 (121 patients) with the mean age of 59.93 ± 10.43 years were compared with group 2 (144 patients) with the mean age of 62.84 ± 10.22 years. Except for age, the 2 groups were not significantly different regarding baseline characteristics. No-reflow phenomenon was less in group 1 with p value = 0.005, whereas incidence of access site bleeding and cerebral hemorrhage were more in this group with p value = 0.001 and 0.049, respectively. During the period of 6 months' follow-up, recurrent angina and recurrent non-STEMI occurred more in group 2 with p value = 0.049 and 0.035, respectively, with no other significant difference between the 2 groups. CONCLUSIONS: No-reflow phenomenon and the risk of recurrent ischemia is significantly lower in patients undergoing PCI very early after successful fibrinolytic therapy, but the risk of bleeding is increased in this time. So it is recommended that patients received successful fibrinolytic therapy to be subjected to very early PCI within 3 to 12 h from fibrinolysis. SN - 2211-8179 UR - https://www.unboundmedicine.com/medline/citation/30098929/Very_Early_Versus_Early_Percutaneous_Coronary_Intervention_After_Successful_Fibrinolytic_Therapy_in_Pharmacoinvasive_Strategy L2 - https://linkinghub.elsevier.com/retrieve/pii/S2211-8160(18)30095-4 DB - PRIME DP - Unbound Medicine ER -