Reduced-Dose Fibrinolytic Acceleration of ST-Segment Elevation Myocardial Infarction Treatment Coupled With Urgent Percutaneous Coronary Intervention Compared to Primary Percutaneous Coronary Intervention Alone. Results of the AMICO (Alliance for Myocardial Infarction Care Optimization) Registry

Ali E. Denktas, Haris Athar, Timothy D. Henry, David M. Larson, Michael Simons, Roger S. Chan, Nathaniel W. Niles, Holger Thiele, Gerhard Schuler, Chul Ahn, Stefano Sdringola, H. Vernon Anderson, Raymond G. McKay, Richard W. Smalling

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objectives: We sought to evaluate the impact of a strategy of reduced-dose fibrinolytic acceleration of ST-segment elevation myocardial infarction (STEMI) treatment followed by urgent percutaneous coronary intervention (FAST-PCI) on the mortality, reinfarction, and stroke rates in STEMI patients as compared with a primary percutaneous coronary intervention (PPCI) approach. Background: Time to reperfusion is a major determinant of mortality among STEMI patients. Rapid initiation of fibrinolytic therapy can shorten time to reperfusion, and mechanical therapy of the culprit lesion is known to be beneficial. Methods: Data from 2,869 STEMI patients treated in 5 high-volume percutaneous coronary intervention (PCI) centers were pooled for analysis. Mortality at 30 days was the primary end point. Death, reinfarction, and stroke were secondary end points, as were infarct-related artery TIMI (Thrombolysis In Myocardial Infarction) flow grade before PCI and shock on arrival to the catheterization laboratory. Results: Compared to PPCI, mortality at 30 days was significantly lower with FAST-PCI (3.8% vs. 6.4%, p = 0.002). The combined triple end point of death, reinfarction, or stroke was also less frequent (5.1% vs. 8.9%, p < 0.0001). The FAST-PCI patients had a lower incidence of Killip class IV (5.6% vs. 10.9%, p < 0.0001) and higher infarct-related artery TIMI flow grades (2.1 ± 1.2 vs. 1.1 ± 1.3, p < 0.0001) upon arrival in the catheterization laboratory. Stepwise logistic regression analysis demonstrated that FAST-PCI was an independent predictor of 30-day mortality (relative risk = 0.542, p = 0.0151). Conclusions: The FAST-PCI strategy reduced the mortality and combined end point of death, reinfarction, and stroke among STEMI patients, without increasing the risk of stroke or bleeding, compared to PPCI. Fibrinolysis before hospital admission also increased the initial infarct-related artery patency and decreased the likelihood of shock at presentation.

Original languageEnglish (US)
Pages (from-to)504-510
Number of pages7
JournalJACC: Cardiovascular Interventions
Volume1
Issue number5
DOIs
StatePublished - Oct 2008

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Percutaneous Coronary Intervention
Registries
Myocardial Infarction
Stroke
Mortality
Therapeutics
Arteries
Catheterization
Reperfusion
Shock
ST Elevation Myocardial Infarction
Thrombolytic Therapy
Fibrinolysis
Logistic Models
Regression Analysis
Hemorrhage

Keywords

  • angioplasty
  • fibrinolysis
  • meta-analysis
  • myocardial infarction
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Reduced-Dose Fibrinolytic Acceleration of ST-Segment Elevation Myocardial Infarction Treatment Coupled With Urgent Percutaneous Coronary Intervention Compared to Primary Percutaneous Coronary Intervention Alone. Results of the AMICO (Alliance for Myocardial Infarction Care Optimization) Registry. / Denktas, Ali E.; Athar, Haris; Henry, Timothy D.; Larson, David M.; Simons, Michael; Chan, Roger S.; Niles, Nathaniel W.; Thiele, Holger; Schuler, Gerhard; Ahn, Chul; Sdringola, Stefano; Anderson, H. Vernon; McKay, Raymond G.; Smalling, Richard W.

In: JACC: Cardiovascular Interventions, Vol. 1, No. 5, 10.2008, p. 504-510.

Research output: Contribution to journalArticle

Denktas, Ali E. ; Athar, Haris ; Henry, Timothy D. ; Larson, David M. ; Simons, Michael ; Chan, Roger S. ; Niles, Nathaniel W. ; Thiele, Holger ; Schuler, Gerhard ; Ahn, Chul ; Sdringola, Stefano ; Anderson, H. Vernon ; McKay, Raymond G. ; Smalling, Richard W. / Reduced-Dose Fibrinolytic Acceleration of ST-Segment Elevation Myocardial Infarction Treatment Coupled With Urgent Percutaneous Coronary Intervention Compared to Primary Percutaneous Coronary Intervention Alone. Results of the AMICO (Alliance for Myocardial Infarction Care Optimization) Registry. In: JACC: Cardiovascular Interventions. 2008 ; Vol. 1, No. 5. pp. 504-510.
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title = "Reduced-Dose Fibrinolytic Acceleration of ST-Segment Elevation Myocardial Infarction Treatment Coupled With Urgent Percutaneous Coronary Intervention Compared to Primary Percutaneous Coronary Intervention Alone. Results of the AMICO (Alliance for Myocardial Infarction Care Optimization) Registry",
abstract = "Objectives: We sought to evaluate the impact of a strategy of reduced-dose fibrinolytic acceleration of ST-segment elevation myocardial infarction (STEMI) treatment followed by urgent percutaneous coronary intervention (FAST-PCI) on the mortality, reinfarction, and stroke rates in STEMI patients as compared with a primary percutaneous coronary intervention (PPCI) approach. Background: Time to reperfusion is a major determinant of mortality among STEMI patients. Rapid initiation of fibrinolytic therapy can shorten time to reperfusion, and mechanical therapy of the culprit lesion is known to be beneficial. Methods: Data from 2,869 STEMI patients treated in 5 high-volume percutaneous coronary intervention (PCI) centers were pooled for analysis. Mortality at 30 days was the primary end point. Death, reinfarction, and stroke were secondary end points, as were infarct-related artery TIMI (Thrombolysis In Myocardial Infarction) flow grade before PCI and shock on arrival to the catheterization laboratory. Results: Compared to PPCI, mortality at 30 days was significantly lower with FAST-PCI (3.8{\%} vs. 6.4{\%}, p = 0.002). The combined triple end point of death, reinfarction, or stroke was also less frequent (5.1{\%} vs. 8.9{\%}, p < 0.0001). The FAST-PCI patients had a lower incidence of Killip class IV (5.6{\%} vs. 10.9{\%}, p < 0.0001) and higher infarct-related artery TIMI flow grades (2.1 ± 1.2 vs. 1.1 ± 1.3, p < 0.0001) upon arrival in the catheterization laboratory. Stepwise logistic regression analysis demonstrated that FAST-PCI was an independent predictor of 30-day mortality (relative risk = 0.542, p = 0.0151). Conclusions: The FAST-PCI strategy reduced the mortality and combined end point of death, reinfarction, and stroke among STEMI patients, without increasing the risk of stroke or bleeding, compared to PPCI. Fibrinolysis before hospital admission also increased the initial infarct-related artery patency and decreased the likelihood of shock at presentation.",
keywords = "angioplasty, fibrinolysis, meta-analysis, myocardial infarction, percutaneous coronary intervention",
author = "Denktas, {Ali E.} and Haris Athar and Henry, {Timothy D.} and Larson, {David M.} and Michael Simons and Chan, {Roger S.} and Niles, {Nathaniel W.} and Holger Thiele and Gerhard Schuler and Chul Ahn and Stefano Sdringola and Anderson, {H. Vernon} and McKay, {Raymond G.} and Smalling, {Richard W.}",
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T1 - Reduced-Dose Fibrinolytic Acceleration of ST-Segment Elevation Myocardial Infarction Treatment Coupled With Urgent Percutaneous Coronary Intervention Compared to Primary Percutaneous Coronary Intervention Alone. Results of the AMICO (Alliance for Myocardial Infarction Care Optimization) Registry

AU - Denktas, Ali E.

AU - Athar, Haris

AU - Henry, Timothy D.

AU - Larson, David M.

AU - Simons, Michael

AU - Chan, Roger S.

AU - Niles, Nathaniel W.

AU - Thiele, Holger

AU - Schuler, Gerhard

AU - Ahn, Chul

AU - Sdringola, Stefano

AU - Anderson, H. Vernon

AU - McKay, Raymond G.

AU - Smalling, Richard W.

PY - 2008/10

Y1 - 2008/10

N2 - Objectives: We sought to evaluate the impact of a strategy of reduced-dose fibrinolytic acceleration of ST-segment elevation myocardial infarction (STEMI) treatment followed by urgent percutaneous coronary intervention (FAST-PCI) on the mortality, reinfarction, and stroke rates in STEMI patients as compared with a primary percutaneous coronary intervention (PPCI) approach. Background: Time to reperfusion is a major determinant of mortality among STEMI patients. Rapid initiation of fibrinolytic therapy can shorten time to reperfusion, and mechanical therapy of the culprit lesion is known to be beneficial. Methods: Data from 2,869 STEMI patients treated in 5 high-volume percutaneous coronary intervention (PCI) centers were pooled for analysis. Mortality at 30 days was the primary end point. Death, reinfarction, and stroke were secondary end points, as were infarct-related artery TIMI (Thrombolysis In Myocardial Infarction) flow grade before PCI and shock on arrival to the catheterization laboratory. Results: Compared to PPCI, mortality at 30 days was significantly lower with FAST-PCI (3.8% vs. 6.4%, p = 0.002). The combined triple end point of death, reinfarction, or stroke was also less frequent (5.1% vs. 8.9%, p < 0.0001). The FAST-PCI patients had a lower incidence of Killip class IV (5.6% vs. 10.9%, p < 0.0001) and higher infarct-related artery TIMI flow grades (2.1 ± 1.2 vs. 1.1 ± 1.3, p < 0.0001) upon arrival in the catheterization laboratory. Stepwise logistic regression analysis demonstrated that FAST-PCI was an independent predictor of 30-day mortality (relative risk = 0.542, p = 0.0151). Conclusions: The FAST-PCI strategy reduced the mortality and combined end point of death, reinfarction, and stroke among STEMI patients, without increasing the risk of stroke or bleeding, compared to PPCI. Fibrinolysis before hospital admission also increased the initial infarct-related artery patency and decreased the likelihood of shock at presentation.

AB - Objectives: We sought to evaluate the impact of a strategy of reduced-dose fibrinolytic acceleration of ST-segment elevation myocardial infarction (STEMI) treatment followed by urgent percutaneous coronary intervention (FAST-PCI) on the mortality, reinfarction, and stroke rates in STEMI patients as compared with a primary percutaneous coronary intervention (PPCI) approach. Background: Time to reperfusion is a major determinant of mortality among STEMI patients. Rapid initiation of fibrinolytic therapy can shorten time to reperfusion, and mechanical therapy of the culprit lesion is known to be beneficial. Methods: Data from 2,869 STEMI patients treated in 5 high-volume percutaneous coronary intervention (PCI) centers were pooled for analysis. Mortality at 30 days was the primary end point. Death, reinfarction, and stroke were secondary end points, as were infarct-related artery TIMI (Thrombolysis In Myocardial Infarction) flow grade before PCI and shock on arrival to the catheterization laboratory. Results: Compared to PPCI, mortality at 30 days was significantly lower with FAST-PCI (3.8% vs. 6.4%, p = 0.002). The combined triple end point of death, reinfarction, or stroke was also less frequent (5.1% vs. 8.9%, p < 0.0001). The FAST-PCI patients had a lower incidence of Killip class IV (5.6% vs. 10.9%, p < 0.0001) and higher infarct-related artery TIMI flow grades (2.1 ± 1.2 vs. 1.1 ± 1.3, p < 0.0001) upon arrival in the catheterization laboratory. Stepwise logistic regression analysis demonstrated that FAST-PCI was an independent predictor of 30-day mortality (relative risk = 0.542, p = 0.0151). Conclusions: The FAST-PCI strategy reduced the mortality and combined end point of death, reinfarction, and stroke among STEMI patients, without increasing the risk of stroke or bleeding, compared to PPCI. Fibrinolysis before hospital admission also increased the initial infarct-related artery patency and decreased the likelihood of shock at presentation.

KW - angioplasty

KW - fibrinolysis

KW - meta-analysis

KW - myocardial infarction

KW - percutaneous coronary intervention

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