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Inpharma 1652 - 23 Aug 2008
Thrombolysis followed by PCIseems a good option in acute MIWhen used early after the onset of symptoms, a
pharmacoinvasive strategy combining thrombolysiswith percutaneous coronary intervention (PCI) yieldssurvival rates similar to those of primary PCI in patientswith ST-segment elevation acute myocardial infarction(MI), conclude researchers from France.1
The study assessed 1714 consecutive patients withST-segment elevation MI over a 1-month period at 223French centres, with 1-year follow-up. A total of 60% ofpatients underwent reperfusion therapy; primary PCI(PPCI) was the main reperfusion method (33%), while29% received thrombolysis (18% of the entirepopulation were treated in the ambulance beforehospital admision). Of the 466 patients who receivedthrombolyisis, 84% underwent PCI during the hospitalstay. Time to initiation of reperfusion therapy was "muchlonger" in patients who underwent PPCI than those whoreceived thrombolysis and subsequent PCI (300 vs 130mins), the researchers note.
Inhospital mortality was highest in patients withoutreperfusion therapy (9.5%), but similar in those whoreceived PPCI and thrombolysis (5.0% vs 4.3%);12-month survival was 91.8% for PPCI and 93.6% forthrombolysis. The researchers say that these findingsmay have "important implications in terms of healthcareorganization", as they suggest that "semiurgent PCIpreceded by timely thrombolysis may be an alternative toPPCI, without the need for widely disseminatedcatheterization laboratories to be available 24 hours perday, 7 days per week".
In an accompanying editorial, Dr Harvey D Whitefrom Auckland City Hospital, Auckland, New Zealand,says that a strategy of rapid adminstration ofthrombolysis followed by systematic PCI within24 hours "would be practical in many communities andmost countries".2
1. Danchin N, et al. Comparison of thrombolysis followed by broad use ofpercutaneous coronary intervention with primary percutaneous coronaryintervention for ST-segment-elevation acute myocardial infarction: data from theFrench Registry on Acute ST-Elevation Myocardial Infarction (FAST-MI).Circulation 118: 268-276, No. 3, 15 Jul 2008.
2. White HD. Systems of care: need for hub-and-spoke systems for both primaryand systematic percutaneous coronary intervention after fibrinolysis. Circulation118: 219-222, No. 3, 15 Jul 2008.
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Inpharma 23 Aug 2008 No. 16521173-8324/10/1652-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved