Linked Life Data

14605015

Source:http://linkedlifedata.com/resource/pubmed/id/14605015

Statements in which the resource exists as a subject.
PredicateObject
rdf:type
lifeskim:mentions
pubmed:issue
16 Suppl 1
pubmed:dateCreated
2003-11-7
pubmed:abstractText
BACKGROUND: Treatment with lytics or primary percutaneous coronary interventions (PCI) reduces the mortality rate of patients with ST-elevation myocardial infarction (STEMI) presenting within 12 hours. Patients presenting >12 hours are generally considered to be ineligible for reperfusion therapy, and there are currently no specific treatment recommendations for this subgroup.Methods- All patients with STEMI <24 hours were included in the Treatment with Enoxaparin and Tirofiban in Acute Myocardial Infarction (TETAMI) randomized trial or registry. Those patients who were ineligible for acute reperfusion, had no cardiogenic shock, and were not planned for revascularization within 48 hours were randomized to 1 of 4 antithrombotic regimens involving enoxaparin or unfractionated heparin (UFH), in combination with tirofiban or placebo for 2 to 8 days. A concurrent registry tracked STEMI patients coming in within <12 hours, and who underwent reperfusion. This registry also tracked the remaining STEMI patients who neither received reperfusion nor were enrolled in the TETAMI randomized trial. The demographics and clinical outcomes of all three groups (received reperfusion therapy, too late for reperfusion and enrolled in the randomized trial, neither received reperfusion therapy nor were enrolled in the randomized trial) were prospectively tracked. RESULTS AND CONCLUSIONS: There were 2,737 patients who presented with STEMI or a new left branch bundle block (LBBB), of which 1,654 (60%) presented < or =12 hours. There were 1,196 (72%) of 1,654 patients who received reperfusion therapy. There were 458 (28%) of the 1,654 patients deemed "ineligible" for reperfusion, mostly because of a contraindication to lytics or for being "too old." In contrast, 1,083 (40%) of 2,737 patients presented >12 hours. Apart from 34 of these patients who had a stuttering infarction and were referred for reperfusion, the remaining patients did not receive reperfusion therapy. Registry patients who received reperfusion therapy, compared with TETAMI randomized patients (all of whom received antithrombotic therapy) and registry patients who did not receive reperfusion, were younger (61 years versus 63 years and 67 years), were more likely to be male (78% versus 73% and 63%), and had persistent ST-segment elevation as opposed to LBBB or Q waves. Registry patients who received reperfusion therapy had better clinical outcomes, even after adjusting for admission Killip class, compared with TETAMI randomized patients and registry patients who did not receive reperfusion therapy. TETAMI randomized patients had better outcomes than registry patients who did not receive reperfusion therapy. The major obstacle to expanding the delivery of reperfusion therapy to patients with STEMI is the large fraction of patients who present too late for reperfusion therapy. Examination of prospectively gathered data on STEMI patients who are ineligible for reperfusion may help optimize their treatment.
pubmed:language
eng
pubmed:journal
pubmed:citationSubset
AIM
pubmed:chemical
pubmed:status
MEDLINE
pubmed:month
Oct
pubmed:issn
1524-4539
pubmed:author
pubmed:issnType
Electronic
pubmed:day
21
pubmed:volume
108
pubmed:owner
NLM
pubmed:authorsComplete
Y
pubmed:pagination
III14-21
pubmed:dateRevised
2009-11-3
pubmed:meshHeading
pubmed-meshheading:14605015-Age Factors, pubmed-meshheading:14605015-Aged, pubmed-meshheading:14605015-Anticoagulants, pubmed-meshheading:14605015-Bundle-Branch Block, pubmed-meshheading:14605015-Double-Blind Method, pubmed-meshheading:14605015-Drug Therapy, Combination, pubmed-meshheading:14605015-Electrocardiography, pubmed-meshheading:14605015-Enoxaparin, pubmed-meshheading:14605015-Female, pubmed-meshheading:14605015-Fibrinolytic Agents, pubmed-meshheading:14605015-Heparin, pubmed-meshheading:14605015-Humans, pubmed-meshheading:14605015-Male, pubmed-meshheading:14605015-Middle Aged, pubmed-meshheading:14605015-Myocardial Infarction, pubmed-meshheading:14605015-Myocardial Reperfusion, pubmed-meshheading:14605015-Platelet Aggregation Inhibitors, pubmed-meshheading:14605015-Prospective Studies, pubmed-meshheading:14605015-Registries, pubmed-meshheading:14605015-Survival Rate, pubmed-meshheading:14605015-Treatment Outcome, pubmed-meshheading:14605015-Tyrosine
pubmed:year
2003
pubmed:articleTitle
Prospective evaluation of clinical outcomes after acute ST-elevation myocardial infarction in patients who are ineligible for reperfusion therapy: preliminary results from the TETAMI registry and randomized trial.
pubmed:affiliation
Cardiac Cath Lab Administration, Newark Beth Israel Medical Center, Newark, NJ 07112, USA. marcohen@sbhcs.com
pubmed:publicationType
Journal Article, Clinical Trial, Comparative Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Multicenter Study