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Titolo:
INTENSIVE MEDICAL THERAPY VERSUS CORONARY ANGIOPLASTY FOR SUPPRESSIONOF MYOCARDIAL-ISCHEMIA IN SURVIVORS OF ACUTE MYOCARDIAL-INFARCTION - A PROSPECTIVE, RANDOMIZED PILOT-STUDY
Autore:
DAKIK HA; KLEIMAN NS; FARMER JA; HE ZX; WENDT JA; PRATT CM; VERANI MS; MAHMARIAN JJ;
Indirizzi:
6550 FANNIN ST,SM-1246 HOUSTON TX 77030 BAYLOR COLL MED,CARDIOL SECT HOUSTON TX 77030
Titolo Testata:
Circulation
fascicolo: 19, volume: 98, anno: 1998,
pagine: 2017 - 2023
SICI:
0009-7322(1998)98:19<2017:IMTVCA>2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
EMISSION COMPUTED-TOMOGRAPHY; PLACEBO-CONTROLLED TRIAL; CARDIAC ISCHEMIA; DOUBLE-BLIND; TL-201 TOMOGRAPHY; ARTERY DISEASE; STABLE ANGINA; PATCH THERAPY; UNITED-STATES; BLOOD-FLOW;
Keywords:
MYOCARDIAL INFARCTION; TOMOGRAPHY; ISCHEMIA;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
39
Recensione:
Indirizzi per estratti:
Citazione:
H.A. Dakik et al., "INTENSIVE MEDICAL THERAPY VERSUS CORONARY ANGIOPLASTY FOR SUPPRESSIONOF MYOCARDIAL-ISCHEMIA IN SURVIVORS OF ACUTE MYOCARDIAL-INFARCTION - A PROSPECTIVE, RANDOMIZED PILOT-STUDY", Circulation, 98(19), 1998, pp. 2017-2023

Abstract

Background-Patients who have inducible ischemia after acute myocardial infarction (AMI) generally undergo coronary angiography with the intent to revascularize, Whether this approach is superior to intensive treatment with anti-ischemic medications is unknown. Methods and Results-We performed a prospective, randomized pilot study comparing intensive medical therapy with coronary angioplasty (PTCA) for suppression ofmyocardial ischemia in 44 stable survivors of AMI. Myocardial ischemia was quantified with adenosine Tl-201 tomography (SPECT) performed 4.5+/-2.9 days after AMI. All patients at baseline had a large total (greater than or equal to 20%) and ischemic (greater than or equal to 10%) left ventricular perfusion defect size (PDS). SPECT was repeated at 43+/-26 days after therapy was optimized. The total stress-induced PDSwas comparably reduced with medical therapy (from 38+/-13% to 26+/-16%; P<0.0001) and PTCA (from 35+/-12% to 20+/-16%; P<0.0001). The reduction in ischemic PDS was also similar (P=NS) in both groups. Cardiac events occurred in 7 of 44 patients over 12+/-5 months. Patients who remained clinically stable had a greater reduction in ischemic PDS (-13+/-9%) than those who had a recurrent cardiac event (-5+/-7%; P<0.02). Event-free survival was superior in the 24 patients who had a significant (greater than or equal to 9%) reduction in PDS (96%) compared withthose who did not (65%; P=0.009). Conclusions-In this small pilot study, intensive medical therapy and PTCA were comparable at suppressing ischemia in stable patients after AMI. Sequential imaging with adenosine SPECT can track changes in PDS after anti-ischemic therapies and thereby predict subsequent outcome. Corroboration of these preliminary findings in a larger cardiac-event trial is warranted.

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Documento generato il 29/03/20 alle ore 15:36:00