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Titolo:
Primary angioplasty versus intravenous thrombolysis in acute myocardial infarction: Can we define subgroups of patients benefiting most from primary angioplasty? Results from the pooled data of the Maximal Individual Therapyin Acute Myocardial Infarction Registry and the Myocardial Infarction Registry
Autore:
Zahn, R; Schiele, R; Schneider, S; Gitt, AK; Wienbergen, H; Seidl, K; Voigtlander, T; Gottwik, M; Berg, G; Altmann, E; Rosahl, W; Senges, J;
Indirizzi:
Herzzentrum Ludwigshafen, Dept Cardiol, D-67063 Ludwigshafen, Germany Herzzentrum Ludwigshafen Ludwigshafen Germany D-67063 wigshafen, Germany Univ Mainz, D-6500 Mainz, Germany Univ Mainz Mainz Germany D-6500Univ Mainz, D-6500 Mainz, Germany Klinikum Nurnberg, Nurnberg, Germany Klinikum Nurnberg Nurnberg GermanyKlinikum Nurnberg, Nurnberg, Germany Univ Kliniken Homburg Saar, Homburg, Germany Univ Kliniken Homburg Saar Homburg Germany mburg Saar, Homburg, Germany Klinikum Friedrichstadt, Dresden, Germany Klinikum Friedrichstadt Dresden Germany riedrichstadt, Dresden, Germany Stadt Klinikum, Dessau, Germany Stadt Klinikum Dessau GermanyStadt Klinikum, Dessau, Germany
Titolo Testata:
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
fascicolo: 7, volume: 37, anno: 2001,
pagine: 1827 - 1835
SICI:
0735-1097(20010601)37:7<1827:PAVITI>2.0.ZU;2-1
Fonte:
ISI
Lingua:
ENG
Soggetto:
PRIMARY CORONARY ANGIOPLASTY; PRACTICE GUIDELINES COMMITTEE; ASSOCIATION TASK-FORCE; ACC/AHA GUIDELINES; EARLY REVASCULARIZATION; IMMEDIATE ANGIOPLASTY; BALLOON ANGIOPLASTY; CARDIOGENIC-SHOCK; CLINICAL-TRIAL; SYMPTOM-ONSET;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
37
Recensione:
Indirizzi per estratti:
Indirizzo: Zahn, R Herzzentrum Ludwigshafen, Dept Cardiol, Bremserstr 79, D-67063 Ludwigshafen, Germany Herzzentrum Ludwigshafen Bremserstr 79 Ludwigshafen Germany D-67063
Citazione:
R. Zahn et al., "Primary angioplasty versus intravenous thrombolysis in acute myocardial infarction: Can we define subgroups of patients benefiting most from primary angioplasty? Results from the pooled data of the Maximal Individual Therapyin Acute Myocardial Infarction Registry and the Myocardial Infarction Registry", J AM COL C, 37(7), 2001, pp. 1827-1835

Abstract

OBJECTIVES We sought to determine the effectiveness of primary angioplastycompared with thrombolysis in clinical practice. BACKGROUND In clinical practice, primary angioplasty for the treatment of acute myocardial infarction (AMI) has not yet been proven more effective than intravenous thrombolysis, nor have subgroups of patients been identifiedwho would perhaps benefit from primary angioplasty. METHODS The pooled data of two AMI registries-the Maximal Individual TheRapy in Acute myocardial infarction (MITRA) study and the myocardial Infarction Registry (MIR)-were analyzed. A total of 9,906 lyric-eligible patients with AMI, with a pre-hospital delay of less than or equal to 12 h, were treated with either primary angioplasty (n = 1,327) or thrombolysis (n = 8,579). RESULTS Despite differences in the patients' characteristics and concomitant diseases between the two groups, the prevalence of adverse risk factors was balanced. Univariate analysis of hospital mortality showed a more favorable course for patients treated with primary angioplasty: 6.4% versus 11.3% (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.43 to 0.67). This was confirmed by logistic regression analysis (multivariate OR 0.58, 95% CI 0.44 to 0.77). Primary angioplasty was associated with a lower mortality inall subgroups analyzed. We observed a significant correlation between mortality and absolute risk reduction (r = 0.82, p < 0.0001) in the different subgroups: as mortality increased, there was an increase in absolute benefitof primary angioplasty compared with thrombolysis. CONCLUSIONS These large registry data showed the effect of primary angioplasty to be more favorable than thrombolysis for the treatment of patients with AMI in clinical practice. This effect was not restricted to special subgroups of patients. As mortality increased, the absolute benefit of primaryangioplasty also increased. (J Am Coll Cardiol 2001;37:1827-35) (C) 2001 by the American College of Cardiology.

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Documento generato il 24/01/20 alle ore 12:26:30