Thrombolytic therapy is the coronar...

Thrombolytic therapy is the coronary artery reperfusion order most commonly used in patients with acute ST-segment elevation myocardial infarction (STEMI). It is unknown

whether immediate mechanical reperfusion (IMR) improves results in patients with STEMI who have contraindications to thrombolytic reperfusion therapy. In this research Grzybowski and colleagues investigated whether IMR provides a mortality benefit in patients with STEMI who are ineligible for thrombolysis.

The contemplation included patients from the National Registry of Myocardial Infarction. Participants were eligible if they had electrocardiographic changes that made them candidates for thrombolytic therapy (defined as STEMI or presum of the present day left bundle branch block), if they had symptom storm within the previous 12 hours, and if they had contraindications to thrombolytic therapy. Eligible patients were divided into sum of two units groups: those who did and those who did not receive IMR (defined as percutaneous coronary intervention or coronary bypass graft surgery within 12 hours of symptom onset) Because this assignment was not random, the authors made statistical adjustments to account for potentially confounding factors and selection biases.

Of the 19917 patients who were eligible for the consideration 4,705 (23.6 percent) received IMR. Overall, 5173 patients (259 percent) died in the hospital. The use of IMR was statistically significantly associated with reduc mortality in all unadjusted and adjusted analyses. All statistical patterns were consistent with this finding excluding for one, which categorized patients through quintile and showed no mortality difference in the first quintile.

In this subject of attention patients with acute STEMI and contraindications to thrombolytic therapy had reductions in mortality associated with IMR treatment of 637 and 458 percent depending onward the statistical model. Because and nothing else 23.6 percent of eligible patients received IMR, the authors glance at that increased use of IMR treatment potentially could resolve into mortality in patients with contraindications to thrombolytic therapy; however, of that kind intervention likely would require prehospital diversion of eligible patients to IMR-capable facilities. This meditation did not identify subgroups of eligible patients who were greatest in quantity likely to benefit from IMR treatment.

Grzybowski M et al. Mortality benefit of immediate revascularization of acute ST-segment elevation myocardial infarction in patients with contraindications to thrombolytic therapy. A propensity analysis. JAMA October 8 2003;290:1891-8

COPYRIGHT 2004 American Academy of Family Physicians

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