Usefulness of Local Delivery of Thrombolytics Before Thrombectomy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (the Delivery of Thrombolytics Before Thrombectomy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention [DISSOLUTION] Randomized Trial)
Thrombus aspiration during percutaneous coronary intervention can result in improved rates of normal epicardial flow and myocardial perfusion, but several unmet needs remain. The purpose of the Delivery of thrombolytIcs before thrombectomy in patientS with ST-segment elevatiOn myocardiaL infarction...
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| Veröffentlicht in: | The American journal of cardiology 2013-09, Vol.112 (5), p.630-635 |
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| creator | Greco, Cesare, MD Pelliccia, Francesco, MD Tanzilli, Gaetano, MD Tinti, Maria Denitza, MD Salenzi, Paola, MD Cicerchia, Cristina, MD Schiariti, Michele, MD Franzoni, Ferdinando, MD Speziale, Giuseppe, MD Gallo, Pietro, MD Gaudio, Carlo, MD |
| description | Thrombus aspiration during percutaneous coronary intervention can result in improved rates of normal epicardial flow and myocardial perfusion, but several unmet needs remain. The purpose of the Delivery of thrombolytIcs before thrombectomy in patientS with ST-segment elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary interventION (DISSOLUTION) trial was to evaluate the hypothesis that local delivery of thrombolytics can enhance the efficacy of thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. A total of 102 patients with ST-segment elevation myocardial infarction and angiographic evidence of massive thrombosis in the culprit artery were randomly assigned to receive a local, intrathrombus bolus of 200,000 U of urokinase (n = 51) or saline solution (n = 51) by way of an infusion microcatheter, followed by manual aspiration thrombectomy. The end points included the final Thrombolysis In Myocardial Infarction flow grade and frame count, myocardial blush grade, 60-minute ST-segment resolution >70%, and major adverse cardiac and cerebrovascular events, defined as the death, reinfarction, stroke, or clinically driven target vessel revascularization at 6 months. The use of intrathrombus urokinase was associated with a significantly higher incidence of Thrombolysis In Myocardial Infarction flow grade 3 (90% vs 66%, p = 0.008) and lower postpercutaneous coronary intervention Thrombolysis In Myocardial Infarction frame count (19 ± 15 vs 25 ± 17, p = 0.033). The postprocedural myocardial perfusion was significantly increased with the use of urokinase (myocardial blush grade 2 or 3, 68% vs 45%, p = 0.028), with more patients showing ST-segment resolution >70% (82% vs 55%, p = 0.006). At 6 months of follow-up, the patients treated with intrathrombus urokinase showed a better major adverse cardiac event-free survival (6% vs 21%; log-rank p = 0.044). In conclusion, local, intrathrombus delivery of thrombolytics before manual thrombectomy improved the postprocedural coronary flow and myocardial perfusion and the 6-month clinical outcomes. |
| doi_str_mv | 10.1016/j.amjcard.2013.04.036 |
| format | Article |
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The purpose of the Delivery of thrombolytIcs before thrombectomy in patientS with ST-segment elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary interventION (DISSOLUTION) trial was to evaluate the hypothesis that local delivery of thrombolytics can enhance the efficacy of thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. A total of 102 patients with ST-segment elevation myocardial infarction and angiographic evidence of massive thrombosis in the culprit artery were randomly assigned to receive a local, intrathrombus bolus of 200,000 U of urokinase (n = 51) or saline solution (n = 51) by way of an infusion microcatheter, followed by manual aspiration thrombectomy. The end points included the final Thrombolysis In Myocardial Infarction flow grade and frame count, myocardial blush grade, 60-minute ST-segment resolution >70%, and major adverse cardiac and cerebrovascular events, defined as the death, reinfarction, stroke, or clinically driven target vessel revascularization at 6 months. The use of intrathrombus urokinase was associated with a significantly higher incidence of Thrombolysis In Myocardial Infarction flow grade 3 (90% vs 66%, p = 0.008) and lower postpercutaneous coronary intervention Thrombolysis In Myocardial Infarction frame count (19 ± 15 vs 25 ± 17, p = 0.033). The postprocedural myocardial perfusion was significantly increased with the use of urokinase (myocardial blush grade 2 or 3, 68% vs 45%, p = 0.028), with more patients showing ST-segment resolution >70% (82% vs 55%, p = 0.006). At 6 months of follow-up, the patients treated with intrathrombus urokinase showed a better major adverse cardiac event-free survival (6% vs 21%; log-rank p = 0.044). In conclusion, local, intrathrombus delivery of thrombolytics before manual thrombectomy improved the postprocedural coronary flow and myocardial perfusion and the 6-month clinical outcomes.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2013.04.036</identifier><identifier>PMID: 23711809</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Angina pectoris ; Cardiology ; Cardiovascular ; Combined Modality Therapy ; Coronary Angiography ; Female ; Fibrinolytic Agents - therapeutic use ; Heart attacks ; Humans ; Infusions, Intralesional ; Male ; Middle Aged ; Myocardial Infarction - therapy ; Percutaneous Coronary Intervention - methods ; Stents ; Thrombectomy - methods ; Thrombolytic Therapy - methods ; Treatment Outcome ; Urokinase-Type Plasminogen Activator - therapeutic use ; Veins & arteries</subject><ispartof>The American journal of cardiology, 2013-09, Vol.112 (5), p.630-635</ispartof><rights>Elsevier Inc.</rights><rights>2013 Elsevier Inc.</rights><rights>Copyright © 2013 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Sep 1, 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c448t-773cb06c43c0d8a6ecebc4d874c11b3ffa329273b84b0d50d2445283b5863a013</citedby><cites>FETCH-LOGICAL-c448t-773cb06c43c0d8a6ecebc4d874c11b3ffa329273b84b0d50d2445283b5863a013</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914913010539$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23711809$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Greco, Cesare, MD</creatorcontrib><creatorcontrib>Pelliccia, Francesco, MD</creatorcontrib><creatorcontrib>Tanzilli, Gaetano, MD</creatorcontrib><creatorcontrib>Tinti, Maria Denitza, MD</creatorcontrib><creatorcontrib>Salenzi, Paola, MD</creatorcontrib><creatorcontrib>Cicerchia, Cristina, MD</creatorcontrib><creatorcontrib>Schiariti, Michele, MD</creatorcontrib><creatorcontrib>Franzoni, Ferdinando, MD</creatorcontrib><creatorcontrib>Speziale, Giuseppe, MD</creatorcontrib><creatorcontrib>Gallo, Pietro, MD</creatorcontrib><creatorcontrib>Gaudio, Carlo, MD</creatorcontrib><title>Usefulness of Local Delivery of Thrombolytics Before Thrombectomy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (the Delivery of Thrombolytics Before Thrombectomy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention [DISSOLUTION] Randomized Trial)</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Thrombus aspiration during percutaneous coronary intervention can result in improved rates of normal epicardial flow and myocardial perfusion, but several unmet needs remain. The purpose of the Delivery of thrombolytIcs before thrombectomy in patientS with ST-segment elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary interventION (DISSOLUTION) trial was to evaluate the hypothesis that local delivery of thrombolytics can enhance the efficacy of thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. A total of 102 patients with ST-segment elevation myocardial infarction and angiographic evidence of massive thrombosis in the culprit artery were randomly assigned to receive a local, intrathrombus bolus of 200,000 U of urokinase (n = 51) or saline solution (n = 51) by way of an infusion microcatheter, followed by manual aspiration thrombectomy. The end points included the final Thrombolysis In Myocardial Infarction flow grade and frame count, myocardial blush grade, 60-minute ST-segment resolution >70%, and major adverse cardiac and cerebrovascular events, defined as the death, reinfarction, stroke, or clinically driven target vessel revascularization at 6 months. The use of intrathrombus urokinase was associated with a significantly higher incidence of Thrombolysis In Myocardial Infarction flow grade 3 (90% vs 66%, p = 0.008) and lower postpercutaneous coronary intervention Thrombolysis In Myocardial Infarction frame count (19 ± 15 vs 25 ± 17, p = 0.033). The postprocedural myocardial perfusion was significantly increased with the use of urokinase (myocardial blush grade 2 or 3, 68% vs 45%, p = 0.028), with more patients showing ST-segment resolution >70% (82% vs 55%, p = 0.006). At 6 months of follow-up, the patients treated with intrathrombus urokinase showed a better major adverse cardiac event-free survival (6% vs 21%; log-rank p = 0.044). In conclusion, local, intrathrombus delivery of thrombolytics before manual thrombectomy improved the postprocedural coronary flow and myocardial perfusion and the 6-month clinical outcomes.</description><subject>Aged</subject><subject>Angina pectoris</subject><subject>Cardiology</subject><subject>Cardiovascular</subject><subject>Combined Modality Therapy</subject><subject>Coronary Angiography</subject><subject>Female</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Infusions, Intralesional</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - therapy</subject><subject>Percutaneous Coronary Intervention - methods</subject><subject>Stents</subject><subject>Thrombectomy - methods</subject><subject>Thrombolytic Therapy - methods</subject><subject>Treatment Outcome</subject><subject>Urokinase-Type Plasminogen Activator - therapeutic use</subject><subject>Veins & arteries</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNrNU02P0zAQDQjEloWfALLEZTmk2LHzdVkE3QUqFVrRVhwQshx70rok9mInFeXX49AC0l64crL8_ObNeOZNFD0heEwwyV7sxqLdSeHUOMGEjjEbY5rdjUakyMuYlITei0YY4yQuCSvPoofe78KVkDR7EJ0lNCekwOXozve1h7pvDHiPbI1mVooGXUGj9-AOA7LaOttWtjl0Wnr0Gmrr4ASC7Gx7QNqgheg0mM6jT7rbouUqXsKmDQC6bmAf3qxB7w92qFYH-amphZO_0LVR4DZWmw1aON2KkHMBTvadMGB7jybWWTOgU9OB2wfJIeqi28J_X-Tnq-lyOZ-tV9P5hy_oozDKtvoHKLRyQf_5o-h-LRoPj0_nebR-c72avItn87fTyatZLBkrujjPqaxwJhmVWBUiAwmVZKrImSSkonUtaFImOa0KVmGVYpUwliYFrdIioyI44zy6OOreOPutB9_xVnsJTXMsnhOWZJjgYJhAfXaLurO9M6G6gUVymuKiDKz0yJLOeu-g5jfHpnCC-WBNvuMna_LBmhwzHqwZ4p6e1PuqBfUn6rcXA-HlkQChHXsNjnsZBiZBaRemyJXV_0xxeUtBNtroYOmvcAD_9zfcJxzz5bAfw3oQGjqQ0pL-BKbNFnY</recordid><startdate>20130901</startdate><enddate>20130901</enddate><creator>Greco, Cesare, MD</creator><creator>Pelliccia, Francesco, MD</creator><creator>Tanzilli, Gaetano, MD</creator><creator>Tinti, Maria Denitza, MD</creator><creator>Salenzi, Paola, MD</creator><creator>Cicerchia, Cristina, MD</creator><creator>Schiariti, Michele, MD</creator><creator>Franzoni, Ferdinando, MD</creator><creator>Speziale, Giuseppe, MD</creator><creator>Gallo, Pietro, MD</creator><creator>Gaudio, Carlo, MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20130901</creationdate><title>Usefulness of Local Delivery of Thrombolytics Before Thrombectomy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (the Delivery of Thrombolytics Before Thrombectomy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention [DISSOLUTION] Randomized Trial)</title><author>Greco, Cesare, MD ; Pelliccia, Francesco, MD ; Tanzilli, Gaetano, MD ; Tinti, Maria Denitza, MD ; Salenzi, Paola, MD ; Cicerchia, Cristina, MD ; Schiariti, Michele, MD ; Franzoni, Ferdinando, MD ; Speziale, Giuseppe, MD ; Gallo, Pietro, MD ; Gaudio, Carlo, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-773cb06c43c0d8a6ecebc4d874c11b3ffa329273b84b0d50d2445283b5863a013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Angina pectoris</topic><topic>Cardiology</topic><topic>Cardiovascular</topic><topic>Combined Modality Therapy</topic><topic>Coronary Angiography</topic><topic>Female</topic><topic>Fibrinolytic Agents - 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The purpose of the Delivery of thrombolytIcs before thrombectomy in patientS with ST-segment elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary interventION (DISSOLUTION) trial was to evaluate the hypothesis that local delivery of thrombolytics can enhance the efficacy of thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. A total of 102 patients with ST-segment elevation myocardial infarction and angiographic evidence of massive thrombosis in the culprit artery were randomly assigned to receive a local, intrathrombus bolus of 200,000 U of urokinase (n = 51) or saline solution (n = 51) by way of an infusion microcatheter, followed by manual aspiration thrombectomy. The end points included the final Thrombolysis In Myocardial Infarction flow grade and frame count, myocardial blush grade, 60-minute ST-segment resolution >70%, and major adverse cardiac and cerebrovascular events, defined as the death, reinfarction, stroke, or clinically driven target vessel revascularization at 6 months. The use of intrathrombus urokinase was associated with a significantly higher incidence of Thrombolysis In Myocardial Infarction flow grade 3 (90% vs 66%, p = 0.008) and lower postpercutaneous coronary intervention Thrombolysis In Myocardial Infarction frame count (19 ± 15 vs 25 ± 17, p = 0.033). The postprocedural myocardial perfusion was significantly increased with the use of urokinase (myocardial blush grade 2 or 3, 68% vs 45%, p = 0.028), with more patients showing ST-segment resolution >70% (82% vs 55%, p = 0.006). At 6 months of follow-up, the patients treated with intrathrombus urokinase showed a better major adverse cardiac event-free survival (6% vs 21%; log-rank p = 0.044). In conclusion, local, intrathrombus delivery of thrombolytics before manual thrombectomy improved the postprocedural coronary flow and myocardial perfusion and the 6-month clinical outcomes.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23711809</pmid><doi>10.1016/j.amjcard.2013.04.036</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9149 |
| ispartof | The American journal of cardiology, 2013-09, Vol.112 (5), p.630-635 |
| issn | 0002-9149 1879-1913 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Angina pectoris Cardiology Cardiovascular Combined Modality Therapy Coronary Angiography Female Fibrinolytic Agents - therapeutic use Heart attacks Humans Infusions, Intralesional Male Middle Aged Myocardial Infarction - therapy Percutaneous Coronary Intervention - methods Stents Thrombectomy - methods Thrombolytic Therapy - methods Treatment Outcome Urokinase-Type Plasminogen Activator - therapeutic use Veins & arteries |
| title | Usefulness of Local Delivery of Thrombolytics Before Thrombectomy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (the Delivery of Thrombolytics Before Thrombectomy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention [DISSOLUTION] Randomized Trial) |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-12T08%3A39%3A56IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Usefulness%20of%20Local%20Delivery%20of%20Thrombolytics%20Before%20Thrombectomy%20in%20Patients%20With%20ST-Segment%20Elevation%20Myocardial%20Infarction%20Undergoing%20Primary%20Percutaneous%20Coronary%20Intervention%20(the%20Delivery%20of%20Thrombolytics%20Before%20Thrombectomy%20in%20Patients%20With%20ST-Segment%20Elevation%20Myocardial%20Infarction%20Undergoing%20Primary%20Percutaneous%20Coronary%20Intervention%20%5BDISSOLUTION%5D%20Randomized%20Trial)&rft.jtitle=The%20American%20journal%20of%20cardiology&rft.au=Greco,%20Cesare,%20MD&rft.date=2013-09-01&rft.volume=112&rft.issue=5&rft.spage=630&rft.epage=635&rft.pages=630-635&rft.issn=0002-9149&rft.eissn=1879-1913&rft.coden=AJCDAG&rft_id=info:doi/10.1016/j.amjcard.2013.04.036&rft_dat=%3Cproquest_cross%3E3045816281%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1421735089&rft_id=info:pmid/23711809&rft_els_id=S0002914913010539&rfr_iscdi=true |