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Comparison of very early treatment with either fibrinolysis or percutaneous coronary intervention facilitated with abciximab with respect to ST recovery and infarct-related artery epicardial flow in patients with acute ST-segment elevation myocardial infarction: the Swedish Early Decision (SWEDES) reperfusion trial

Författare och institution:
L. Svensson (-); M. Aasa (-); Mikael Dellborg (Institutionen för medicin, avdelningen för akut och kardiovaskulär medicin); C. M. Gibson (-); A. Kirtane (-); Johan Herlitz (Institutionen för medicin, avdelningen för molekylär och klinisk medicin); A. Ohlsson (-); Thomas Karlsson (Institutionen för medicin, avdelningen för molekylär och klinisk medicin); Lars Grip (Institutionen för medicin, avdelningen för molekylär och klinisk medicin)
Publicerad i:
Am Heart J, 151 ( 4 ) s. 798 e1-7
1097-6744 (Electronic)
Artikel, refereegranskad vetenskaplig
Sammanfattning (abstract):
BACKGROUND: Results from a number of studies indicate that primary percutaneous coronary intervention (PCI) is superior to fibrinolysis for treatment of acute ST-elevation myocardial infarction. Modern adjunctive antithrombotic treatment with systematic use of low-molecular-weight heparins, fibrin-specific thrombolysis, and glycoprotein IIb/IIIa receptor inhibitors may improve the outcome compared with what was achieved in previous studies. METHODS: Patients with ST-elevation myocardial infarction were randomized to receive enoxaparin followed by reteplase (group A; n = 104) or enoxaparin followed by abciximab and transfer to invasive center for optional PCI (group B; n = 101). Primary end points were ST-segment resolution 120 minutes and TIMI flow at coronary angiography 5 to 7 days after randomization. RESULTS: Forty-two percent of the patients started therapy in the prehospital phase. Time from symptom to treatment was 114 minutes in group A and 202 minutes in group B. Baseline characteristics were similar in the 2 groups. Sixty-four percent in group A and 68% in group B had ST resolution of > 50% at 120 minutes (not significant). At control angiography, 54% in the fibrinolytic group and 71% in the invasive group had TIMI 3 flow (P = .04). At 30 days, the composite of death, stroke, or reinfarction occurred in 8% in the fibrinolytic group compared with 3% in the invasive group (not significant). CONCLUSIONS: Despite much shorter time delay to start of fibrinolysis than PCI, this did not result in signs of superior myocardial reperfusion. Epicardial flow in the infarct-related artery was better after invasive therapy, and there was a trend toward better clinical outcome after this treatment compared with after fibrinolysis.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
Adult, Aged, *Angioplasty, Transluminal, Percutaneous Coronary, Antibodies, Monoclonal/*therapeutic use, Antifibrinolytic Agents/*therapeutic use, Coronary Angiography, Enoxaparin/*therapeutic use, Female, Humans, Immunoglobulin Fab Fragments/*therapeutic use, Male, Middle Aged, Myocardial Infarction/*drug therapy/radiography, Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors, Regional Blood Flow, *Thrombolytic Therapy, Time Factors, Treatment Outcome
Postens nummer:
Posten skapad:
2007-09-27 12:18
Posten ändrad:
2011-01-20 09:59

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