Tcheng Primary Angioplasty in Acute Myocardial Infarction

2. Auflage 2009
ISBN: 978-1-60327-497-5
Verlag: Humana Press
Format: PDF
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 225 Seiten

The past 50 years have witnessed a breathtaking evolution in the approaches to the patient with an acute ST elevation myocardial infarction. In the 1960s, the now commonplace cardiac intensive care unit was but a nascent idea. Without much to offer the patient but weeks of absolute bedrest, substantial morbidity and high rates of mortality were the norm. Just 30 years ago, seminal discoveries by DeWood and colleagues suggested that the culprit was plaque rupture with thrombosis, not progressive luminal compromise. Subsequent fibrinolyt- based strategies resulted in a halving of the mortality of acute myocardial infarction. With the introduction of balloon angioplasty in the late 1970s, a few interventional cardiologists braved the question: why not perform emergency angioplasty as a primary reperfusion strategy? Indeed, reports of successful reperfusion via balloon angioplasty appeared (mostly in local newspapers) as early as 1980. Despite being thought of as heretical by mainstream cardiology, these pioneers nonetheless persevered, proving the benefit of ''state-of-the-art'' balloon angioplasty compared with ''state-of-t- art'' thrombolytic therapy in a series of landmark trials published in the New England Journal of Medicine in March of 1993. Publication of the first edition of Primary Angioplasty in Acute Myocardial Infarction in 2002 to some extent anticipated the widespread acceptance of primary percutaneous coronary intervention as the standard of care. Since then, in all respects, the evolution of emergency percutaneous revascularization has only accelerated. The universal replacement of balloon angioplasty with stent implantation was clearly one key.

Autoren/Hrsg.

Tcheng, James

Inhaltsverzeichnis

1;Preface;6
2;Contents;8
3;Contributors;10
4;Overview, Rationale, and Lexicon: Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction;12
4.1;References;15
5;Comparison of Reperfusion Strategies for ST Elevation Acute Myocardial Infarction: Primary Coronary Intervention Versus Fibrinolysis;20
5.1;Historical Background;20
5.2;Comparison of Clinical Outcomes;21
5.2.1;Clinical Outcomes from Randomized Trials;21
5.2.2;Clinical Outcomes from Registries;23
5.3;Comparison of Angiographic Outcomes and Myocardial Salvage;25
5.3.1;Angiographic Outcomes;25
5.3.2;Myocardial Salvage;26
5.4;ACC/AHA and ESC Guidelines for Reperfusion in STEMI;27
5.5;Fibrinolysis Versus Transfer for Primary PCI in Patients Presenting to Non-PCI Hospitals;28
5.6;Primary PCI as a Reperfusion Strategy;30
5.7;Conclusions;31
5.8;References;32
6;Operator and Site Requirements for Primary Coronary Intervention;37
6.1;General Considerations;38
6.2;Prehospital Phase;38
6.3;Staffing Issues;39
6.4;Pharmacological Requirements;40
6.5;Operator and Institutional Requirements;41
6.6;Requirement for On-site Surgical Backup;44
6.7;Primary PCI: Community Versus Tertiary Care Hospital;48
6.7.1;The Case for Community Hospital Primary PCI;48
6.7.2;The Case for Transfer to a Tertiary Care Hospital for Primary PCI;49
6.8;Performance Improvement: Strategies for Decreasing Door to Balloon Times;50
6.9;Quality Assurance: Audit and Peer Review;51
6.10;Conclusions;52
6.11;References;53
7;Primary Coronary Intervention: The Technical Approach;57
7.1;Introduction;57
7.2;Initial Contact;57
7.3;Pre-Procedure Evaluation;58
7.4;Entry into the Catheterization Laboratory;59
7.5;Coronary Angiography;60
7.6;Crossing the Lesion;60
7.7;Coronary Intervention;62
7.8;Multilesion PCI During Primary Angioplasty;64
7.9;Arrhythmia Management;65
7.10;Mechanical Complications of Infarction and Intervention;65
7.11;Thrombotic Complications;66
7.12;Alternative Devices;68
7.13;Conclusions;69
7.14;References;69
8;Primary Coronary Intervention in Community Hospitals with Off-Site Cardiac Surgery Backup: Rationale and Steps to Quality;74
8.1;Primary Coronary Intervention at Hospitals Without Cardiac Surgery: Role and Rationale;74
8.2;Justification for Primary Coronary Intervention Programs in Hospitals Without Cardiac Surgery;76
8.3;Key Program Elements for Hospitals Considering Primary Pci with Off-Site Cardiac Surgery Backup;79
8.3.1;Interdisciplinary Acute Myocardial Infarction Quality Improvement Team;79
8.4;Primary PCI Care Plans;81
8.5;Ongoing Interdisciplinary Efforts to Reduce D2B Times;84
8.6;Conclusions;87
8.7;References;88
9;Reducing System and Process Barriers: The RACE to Improve Door to Balloon Performance;93
9.1;Introduction;93
9.2;Systematic Barriers to Care;93
9.3;Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments;94
9.4;Funding, Leadership, and Oversight;95
9.5;Organization and Development;96
9.6;Implementation and Interventions;99
9.7;Results;103
9.8;Appendix;104
9.9;References;107
10;Rescue Coronary Intervention for Failed Thrombolysis;108
10.1;Introduction;108
10.2;Technical considerations;109
10.3;Key clinical factors supporting the rescue angioplasty approach;110
10.4;The evidence behind rescue PCI;111
10.4.1;Observational studies and retrospective subgroup analyses;111
10.4.2;Randomized Clinical Trials;111
10.5;Role of Delayed PCI in patients with ST-segment elevation MI;116
10.6;Conclusions;117
10.7;References;118
11;Facilitated Percutaneous Coronary Intervention;121
11.1;Introduction;121
11.2;Fibrinolysis-Facilitated PCI;122
11.2.1;Fibrinolysis Alone;122
11.2.1.1;Meta-Analyses;123
11.2.2;Reduced-Dose Fibrinolysis with Glycoprotein IIb/IIIa Inhibitors;125
11.2.2.1;Meta-Analysis;126
11.3;Non-Fibrinolysis-Facilitated PCI;127
11.3.1;High Dose Heparin;127
11.3.2;Glycoprotein IIb/IIIa Receptor Antagonists;128
11.3.2.1;Tirofiban;128
11.3.2.2;Abciximab;129
11.3.2.3;Eptifibatide;130
11.3.2.4;Meta-Analysis;132
11.4;Discussion and Conclusions;132
11.5;References;135
11.6;Appendix: Trial GlossaryPACTPlasminogen-activator Angioplasty Compatibility TrialPRAGUEPRimary Angioplasty in patients transferred from General community hospitals to specialized PTCA Units with or without Emergency thrombolysisGRACIA-2Grupo de Análisis de la Cardiopatía Isquémica Aguda-2 (Primary versus facilitated PCI [tenecteplase plus stenting] in patients with ST-elevated myocardial infarction)ASSENT-4Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Interven;121
12;Therapies Targeted at Preserving Microvascular Integrity and Preventing Reperfusion Injury;140
12.1;Microvascular Obstruction and Reperfusion Injury;140
12.2;Imaging Microvascular Obstruction;142
12.3;Clinical Management of No Reflow;143
12.4;Endothelium-Independent Vasodilators;145
12.4.1;Nitroglycerin;145
12.4.2;Adenosine;145
12.4.3;Nitroprusside;147
12.4.4;Papaverine;148
12.5;Calcium Channel Blockers;148
12.5.1;Verapamil;149
12.5.2;Diltiazem;149
12.5.3;Nicardipine;150
12.6;Anticoagulants, Platelet Inhibitors, and Thromobolytics;150
12.6.1;Unfractionated Heparin;150
12.6.2;Thrombolytic Drugs with Primary PCI;151
12.6.3;GP IIb/IIIa Inhibitors;151
12.6.4;Clopidogrel;153
12.7;Other Drugs and Experimental Strategies;154
12.7.1;Surfactants;154
12.7.2;ATP-sensitive Potassium Channel Openers: Nicorandil and Diazoxide;155
12.7.3;Agents for Direct Myocardial Protection: Cariporide and Trimetazidine;156
12.7.4;Modulators of Free-radical Injury: Recombinant Human Superoxide Dismutase (h-SOD) and Fluosol;157
12.7.5;Other Strategies;158
12.8;Catheterization Technique;159
12.8.1;Considerations for Drug Delivery;159
12.8.2;Local Drug Delivery to the Arterial Wall;160
12.8.3;Ischemic Preconditioning and Postconditioning;161
12.9;Contrast Agents;162
12.10;Conclusions;163
12.11;References;163
13;Platelet Glycoprotein IIb/IIIa Receptor Blockade in Primary Coronary Intervention;173
13.1;Rationale for Utilization of Platelet Receptor Blockers in Acute Myocardial Infarction;173
13.1.1;Platelet Activity in Acute Myocardial Infarction - Thrombus Composition;173
13.1.2;Primary Angioplasty and Platelet Activation;174
13.2;Experimental Evidence - The Concept of Dethrombosis;175
13.3;The No-Reflow Phenomenon;177
13.4;Observational Data;178
13.4.1;The EPIC Trial;178
13.4.2;IMPACT-II and RESTORE Trials;179
13.4.3;The Mayo Clinic Registry;179
13.5;Data from Randomized Clinical Trials;180
13.5.1;The GRAPE Trial;180
13.5.2;The RAPPORT Trial;180
13.5.3;The Munich Experience;182
13.5.4;The ADMIRAL Trial;183
13.5.5;The CADILLAC Trial;184
13.5.6;The INAMI Study;186
13.5.7;The ACE Trial;186
13.5.8;Topol Pooled Analysis;187
13.5.9;The (TITAN)-TIMI 34 Trial;187
13.5.10;Montalescot Meta-Analysis;188
13.5.11;De Luca Meta-Analysis;188
13.5.12;Glycoprotein IIb/IIIa Inhibitors and Reduced dose Fibrinolytics;189
13.6;Future Directions;190
13.6.1;Upstream GP IIb/IIIa Inhibitor Administration and Facilitated PCI;190
13.6.2;Intracoronary GP IIb/IIIa Inhibitor Administration;190
13.7;Supplementary Recommendations;191
13.7.1;Heparin Dosing;191
13.7.2;Vasodilator Therapy;191
13.7.3;Sheath Removal;192
13.7.4;Summary and Conclusions;192
13.8;References;193
14;Cell Therapy in Acute Myocardial Infarction;199
14.1;Introduction;199
14.2;Preclinical Science;200
14.3;Clinical Trials, Cell Types, and Delivery Strategies;200
14.3.1;Autologous Whole Bone Marrow by Intracoronary Infusion;200
14.3.2;Circulating Progenitor Cells;202
14.3.3;Mesenchymal Stem Cells;202
14.3.4;Skeletal Myoblasts;203
14.3.5;Cardiac Stem Cells;204
14.4;Summary and Conclusions;204
14.5;References;204
15;Health Economics of Primary PCI;208
15.1;Introduction;208
15.2;Cost Analysis;209
15.3;Cost-Effectiveness Analysis;210
15.4;Economics of Primary PCI;212
15.5;Primary PCI vs. Thrombolysis;212
15.6;Economics of Primary PCI vs. thrombolysis in the current era;214
15.7;Conclusions;215
15.8;References;215
16;Subject Index;217