ST elevation myocardial infarction management of patients who were not reperfused

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

STEMI patients who do not receive reperfusion therapy can be stratified for a differed mortality risk than those who do. The ACC/AHA guidelines recommend specific guidelines for care in this patient population.

Clinical Trial Data

[1]

Adjusted probability of death or cerebral bleeding in relation to fibrinolytic therapy in patients with ST elevation myocardial infarction (STEMI) who were 75 years or older (dotted line) versus that among patients with STEMI not receiving fibrinolysis (solid line). At 30 days and 1 year this was 23% and 32% versus 26% and 36%, respectively.

2013 Revised ACCF/AHA Guidelines for the Management of ST-Elevation Myocardial Infarction (DO NOT EDIT)[2]

PCI of an Infarct Artery in Patients Who Initially Were Managed With Fibrinolysis or Who Did Not Receive Reperfusion Therapy (DO NOT EDIT)[2]

Class I
"1. PCI of an anatomically significant stenosis in the infarct artery should be performed in patients with suitable anatomy and any of the following:
"a. Cardiogenic shock or acute severe HF[3](Level of Evidence: B)"
"b. Intermediate- or high-risk findings on predischarge noninvasive ischemia testing[4][5](Level of Evidence: C)"
"c. Myocardial ischemia that is spontaneous or provoked by minimal exertion during hospitalization.(Level of Evidence: C)"
Class III (No Benefit)
"1. Delayed PCI of a totally occluded infarct artery greater than 24 hours after STEMI should not be performed in asymptomatic patients with 1- or 2-vessel disease if they are hemodynamically and electrically stable and do not have evidence of severe ischemia.[6][7] (Level of Evidence: B)"
Class IIa
"1. Delayed PCI is reasonable in patients with STEMI and evidence of failed reperfusion or reocclusion after fibrinolytic therapy. PCI can be performed as soon as logistically feasible at the receiving hospital.[8][9][10][11](Level of Evidence: B)"
"2. Delayed PCI of a significant stenosis in a patent infarct artery is reasonable in stable patients with STEMI after fibrinolytic therapy. PCI can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy.[12][13][14][15][16][17](Level of Evidence: B)"
Class IIb
"1. Delayed PCI of a significant stenosis in a patent infarct artery greater than 24 hours after STEMI may be considered as part of an invasive strategy in stable patients.[6][4][5][18][19][20][7][21][22](Level of Evidence: B)"

Sources

  • 2013 Revised ACCF/AHA Guidelines for the Management of ST-Elevation Myocardial Infarction [2]

References

  1. ↑ Stenestrand U, Wallentin L (April 2003). "Fibrinolytic therapy in patients 75 years and older with ST-segment-elevation myocardial infarction: one-year follow-up of a large prospective cohort". Arch. Intern. Med. 163 (8): 965–71. doi:10.1001/archinte.163.8.965. PMID 12719207.
  2. ↑ 2.0 2.1 2.2 O'Gara PT, Kushner FG, Ascheim DD, et al. (December 2012). "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e3182742c84. PMID 23247303.
  3. ↑ Hochman JS, Sleeper LA, White HD, et al. (January 2001). "One-year survival following early revascularization for cardiogenic shock". JAMA 285 (2): 190–2. PMID 11176812.
  4. ↑ 4.0 4.1 Erne P, Schoenenberger AW, Burckhardt D, et al. (May 2007). "Effects of percutaneous coronary interventions in silent ischemia after myocardial infarction: the SWISSI II randomized controlled trial". JAMA 297 (18): 1985–91. doi:10.1001/jama.297.18.1985. PMID 17488963.
  5. ↑ 5.0 5.1 Madsen JK, Grande P, Saunamäki K, et al. (August 1997). "Danish multicenter randomized study of invasive versus conservative treatment in patients with inducible ischemia after thrombolysis in acute myocardial infarction (DANAMI). DANish trial in Acute Myocardial Infarction". Circulation 96 (3): 748–55. PMID 9264478.
  6. ↑ 6.0 6.1 Hochman JS, Lamas GA, Buller CE, et al. (December 2006). "Coronary intervention for persistent occlusion after myocardial infarction". N. Engl. J. Med. 355 (23): 2395–407. doi:10.1056/NEJMoa066139. PMID 17105759.
  7. ↑ 7.0 7.1 Ioannidis JP, Katritsis DG (December 2007). "Percutaneous coronary intervention for late reperfusion after myocardial infarction in stable patients". Am. Heart J. 154 (6): 1065–71. doi:10.1016/j.ahj.2007.07.049. PMID 18035076.
  8. ↑ Sutton AG, Campbell PG, Graham R, et al. (July 2004). "A randomized trial of rescue angioplasty versus a conservative approach for failed fibrinolysis in ST-segment elevation myocardial infarction: the Middlesbrough Early Revascularization to Limit INfarction (MERLIN) trial". J. Am. Coll. Cardiol. 44 (2): 287–96. doi:10.1016/j.jacc.2003.12.059. PMID 15261920.
  9. ↑ Gibson CM, Murphy SA, Rizzo MJ, et al. (April 1999). "Relationship between TIMI frame count and clinical outcomes after thrombolytic administration. Thrombolysis In Myocardial Infarction (TIMI) Study Group". Circulation 99 (15): 1945–50. PMID 10208996.
  10. ↑ Gibson CM, Cannon CP, Murphy SA, Marble SJ, Barron HV, Braunwald E (April 2002). "Relationship of the TIMI myocardial perfusion grades, flow grades, frame count, and percutaneous coronary intervention to long-term outcomes after thrombolytic administration in acute myocardial infarction". Circulation 105 (16): 1909–13. PMID 11997276.
  11. ↑ Sutton AG, Campbell PG, Price DJ, et al. (August 2000). "Failure of thrombolysis by streptokinase: detection with a simple electrocardiographic method". Heart 84 (2): 149–56. PMID 10908249.
  12. ↑ Bøhmer E, Hoffmann P, Abdelnoor M, Arnesen H, Halvorsen S (January 2010). "Efficacy and safety of immediate angioplasty versus ischemia-guided management after thrombolysis in acute myocardial infarction in areas with very long transfer distances results of the NORDISTEMI (NORwegian study on DIstrict treatment of ST-elevation myocardial infarction)". J. Am. Coll. Cardiol. 55 (2): 102–10. doi:10.1016/j.jacc.2009.08.007. PMID 19747792.
  13. ↑ Borgia F, Goodman SG, Halvorsen S, et al. (September 2010). "Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation myocardial infarction: a meta-analysis". Eur. Heart J. 31 (17): 2156–69. doi:10.1093/eurheartj/ehq204. PMID 20601393.
  14. ↑ Cantor WJ, Fitchett D, Borgundvaag B, et al. (June 2009). "Routine early angioplasty after fibrinolysis for acute myocardial infarction". N. Engl. J. Med. 360 (26): 2705–18. doi:10.1056/NEJMoa0808276. PMID 19553646.
  15. ↑ Sosnowski C (April 2008). "[Commentary to the article: Di Mario C, Dudek D, Piscione F, et al.; CARESS-in-AMI (Combined Abciximab RE-teplase Stent Study in Acute Myocardial Infarction) Investigators. Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined Abciximab REteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI): an open, prospective, randomised, multicentre trial. Lancet 2008; 371: 559-68]" (in Polish). Kardiol Pol 66 (4): 461–4; discussion 465–6. PMID 18634182.
  16. ↑ Fernandez-Avilés F, Alonso JJ, Castro-Beiras A, et al. (2004). "Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA-1): a randomised controlled trial". Lancet 364 (9439): 1045–53. doi:10.1016/S0140-6736(04)17059-1. PMID 15380963.
  17. ↑ White HD (July 2008). "Systems of care: need for hub-and-spoke systems for both primary and systematic percutaneous coronary intervention after fibrinolysis". Circulation 118 (3): 219–22. doi:10.1161/CIRCULATIONAHA.108.790170. PMID 18625904.
  18. ↑ D'Souza SP, Mamas MA, Fraser DG, Fath-Ordoubadi F (April 2011). "Routine early coronary angioplasty versus ischaemia-guided angioplasty after thrombolysis in acute ST-elevation myocardial infarction: a meta-analysis". Eur. Heart J. 32 (8): 972–82. doi:10.1093/eurheartj/ehq398. PMID 21036776.
  19. ↑ Gupta M, Chang WC, Van de Werf F, et al. (September 2003). "International differences in in-hospital revascularization and outcomes following acute myocardial infarction: a multilevel analysis of patients in ASSENT-2". Eur. Heart J. 24 (18): 1640–50. PMID 14499226.
  20. ↑ Gibson CM, Karha J, Murphy SA, et al. (July 2003). "Early and long-term clinical outcomes associated with reinfarction following fibrinolytic administration in the Thrombolysis in Myocardial Infarction trials". J. Am. Coll. Cardiol. 42 (1): 7–16. PMID 12849652.
  21. ↑ Steg PG, Thuaire C, Himbert D, et al. (December 2004). "DECOPI (DEsobstruction COronaire en Post-Infarctus): a randomized multi-centre trial of occluded artery angioplasty after acute myocardial infarction". Eur. Heart J. 25 (24): 2187–94. doi:10.1016/j.ehj.2004.10.019. PMID 15589635.
  22. ↑ Wilson SH, Bell MR, Rihal CS, Bailey KR, Holmes DR, Berger PB (May 2001). "Infarct artery reocclusion after primary angioplasty, stent placement, and thrombolytic therapy for acute myocardial infarction". Am. Heart J. 141 (5): 704–10. doi:10.1067/mhj.2001.114971. PMID 11320356.
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