Benefit of late coronary reperfusion in patients with acute myocardial infarction and persistent ischemic chest pain
The benefit of thrombolytic therapy given late after the onset of acute myocardial infarction (AMI) has been controversial because of low reperfusion rates and limited myocardial salvage. Persistent chest pain has been used as a criteria for late intervention, but there is little documentation to va...
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| Veröffentlicht in: | The American journal of cardiology 1994-09, Vol.74 (6), p.538-543 |
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| container_title | The American journal of cardiology |
| container_volume | 74 |
| creator | Brodie, Bruce R. Stuckey, Thomas D. Hansen, Charles Muncy, Denise Weintraub, Richard A. LeBauer, E.Joseph Kelly, Thomas A. Katz, Jeffrey D. Berry, Jonathan J. |
| description | The benefit of thrombolytic therapy given late after the onset of acute myocardial infarction (AMI) has been controversial because of low reperfusion rates and limited myocardial salvage. Persistent chest pain has been used as a criteria for late intervention, but there is little documentation to validate this practice. Clinical outcomes and myocardial salvage were evaluated in 74 patients with AMI and persistent chest pain who underwent late reperfusion (>6 hours) with direct coronary angioplasty, and these were compared with outcomes in 460 patients with early reperfusion (≤6 hours). Patients with late reperfusion had a high infarct artery patency rate (96%), a low hospital mortality rate (5.4%), and a low incidence of reinfarction (1.4%) and recurrent ischemia that were similar to patients with early reperfusion. Patients with late reperfusion had surprisingly good recovery of left ventricular function with improvement in ejection fraction from 50% to 60% at follow-up angiography. Patients with late reperfusion had a greater incidence of collateral flow (45% vs 22%, p < 0.001) and a lower value of peak creatine kinase (1,357 vs 2,057 U/liter, p < 0.001) than patients with early reperfusion. This study emphasizes the importance of persistent chest pain as a marker of continued myocardial viability in patients who present late after AMI. These data suggest that the probable mechanism of continued viability is preserved flow to the infarct zone. Patients with AMI and persistent chest pain may benefit from reperfusion therapy beyond 6 to 12 hours. |
| doi_str_mv | 10.1016/0002-9149(94)90740-4 |
| format | Article |
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Persistent chest pain has been used as a criteria for late intervention, but there is little documentation to validate this practice. Clinical outcomes and myocardial salvage were evaluated in 74 patients with AMI and persistent chest pain who underwent late reperfusion (>6 hours) with direct coronary angioplasty, and these were compared with outcomes in 460 patients with early reperfusion (≤6 hours). Patients with late reperfusion had a high infarct artery patency rate (96%), a low hospital mortality rate (5.4%), and a low incidence of reinfarction (1.4%) and recurrent ischemia that were similar to patients with early reperfusion. Patients with late reperfusion had surprisingly good recovery of left ventricular function with improvement in ejection fraction from 50% to 60% at follow-up angiography. Patients with late reperfusion had a greater incidence of collateral flow (45% vs 22%, p < 0.001) and a lower value of peak creatine kinase (1,357 vs 2,057 U/liter, p < 0.001) than patients with early reperfusion. This study emphasizes the importance of persistent chest pain as a marker of continued myocardial viability in patients who present late after AMI. These data suggest that the probable mechanism of continued viability is preserved flow to the infarct zone. Patients with AMI and persistent chest pain may benefit from reperfusion therapy beyond 6 to 12 hours.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/0002-9149(94)90740-4</identifier><identifier>PMID: 8074034</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Angina Pectoris - mortality ; Angina Pectoris - physiopathology ; Angina Pectoris - therapy ; Angioplasty ; Angioplasty, Balloon, Coronary ; Biological and medical sciences ; Cardiology. Vascular system ; Cardiovascular disease ; Chi-Square Distribution ; Confounding Factors (Epidemiology) ; Coronary heart disease ; Drug therapy ; Female ; Heart ; Hospital Mortality ; Humans ; Male ; Medical research ; Medical sciences ; Middle Aged ; Myocardial Infarction - mortality ; Myocardial Infarction - physiopathology ; Myocardial Infarction - therapy ; Pain ; Recurrence ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Vascular Patency ; Ventricular Function, Left</subject><ispartof>The American journal of cardiology, 1994-09, Vol.74 (6), p.538-543</ispartof><rights>1994</rights><rights>1994 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. 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Persistent chest pain has been used as a criteria for late intervention, but there is little documentation to validate this practice. Clinical outcomes and myocardial salvage were evaluated in 74 patients with AMI and persistent chest pain who underwent late reperfusion (>6 hours) with direct coronary angioplasty, and these were compared with outcomes in 460 patients with early reperfusion (≤6 hours). Patients with late reperfusion had a high infarct artery patency rate (96%), a low hospital mortality rate (5.4%), and a low incidence of reinfarction (1.4%) and recurrent ischemia that were similar to patients with early reperfusion. Patients with late reperfusion had surprisingly good recovery of left ventricular function with improvement in ejection fraction from 50% to 60% at follow-up angiography. Patients with late reperfusion had a greater incidence of collateral flow (45% vs 22%, p < 0.001) and a lower value of peak creatine kinase (1,357 vs 2,057 U/liter, p < 0.001) than patients with early reperfusion. This study emphasizes the importance of persistent chest pain as a marker of continued myocardial viability in patients who present late after AMI. These data suggest that the probable mechanism of continued viability is preserved flow to the infarct zone. Patients with AMI and persistent chest pain may benefit from reperfusion therapy beyond 6 to 12 hours.</description><subject>Aged</subject><subject>Angina Pectoris - mortality</subject><subject>Angina Pectoris - physiopathology</subject><subject>Angina Pectoris - therapy</subject><subject>Angioplasty</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular disease</subject><subject>Chi-Square Distribution</subject><subject>Confounding Factors (Epidemiology)</subject><subject>Coronary heart disease</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Heart</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - physiopathology</subject><subject>Myocardial Infarction - therapy</subject><subject>Pain</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vascular Patency</subject><subject>Ventricular Function, Left</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1994</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU-LFDEQxYMo6-zqN1AIIoseWpNOpTu5CLr4Dxa86Dlkk2o2S3cyJmllv71pZ5iDB09FqN-rPN4j5Blnbzjjw1vGWN9pDvqVhteajcA6eEB2XI2645qLh2R3Qh6T81Lu2pNzOZyRM7XhAnakfsCIU6g0TXS2FalLOUWb72nGPeZpLSFFGiLd2xow1kJ_h3pLrVsbu9wnZ7MPdm7EZLOrG2yjp01aQqlNQENxt7gER9sotd0J8Ql5NNm54NPjvCA_Pn38fvWlu_72-evV--vOAfS1AyGF0A6kUhKQWe6Re66tGqwe1Ogt9EKqGy24dpIp7YUahomNggMwBUJckMvD3X1OP9f2u1maG5xnGzGtxYzDoHomN_DFP-BdWnNs3kwvmJBcyr5BcIBcTqVknMw-h6VFZTgzWyNmi9tscRsN5m8jBprs-fH2erOgP4mOFbT9y-PeFmfnKdvoQjlh0Peg1dCwdwcMW2C_AmZTXCvEoQ8ZXTU-hf_7-AOyb6Zx</recordid><startdate>19940915</startdate><enddate>19940915</enddate><creator>Brodie, Bruce R.</creator><creator>Stuckey, Thomas D.</creator><creator>Hansen, Charles</creator><creator>Muncy, Denise</creator><creator>Weintraub, Richard A.</creator><creator>LeBauer, E.Joseph</creator><creator>Kelly, Thomas A.</creator><creator>Katz, Jeffrey D.</creator><creator>Berry, Jonathan J.</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><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>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>19940915</creationdate><title>Benefit of late coronary reperfusion in patients with acute myocardial infarction and persistent ischemic chest pain</title><author>Brodie, Bruce R. ; Stuckey, Thomas D. ; Hansen, Charles ; Muncy, Denise ; Weintraub, Richard A. ; LeBauer, E.Joseph ; Kelly, Thomas A. ; Katz, Jeffrey D. ; Berry, Jonathan J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-435339c458854e0a1de1d19a86a9687da42358b9319c5089d3866f07314408433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1994</creationdate><topic>Aged</topic><topic>Angina Pectoris - mortality</topic><topic>Angina Pectoris - physiopathology</topic><topic>Angina Pectoris - therapy</topic><topic>Angioplasty</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular disease</topic><topic>Chi-Square Distribution</topic><topic>Confounding Factors (Epidemiology)</topic><topic>Coronary heart disease</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Heart</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - physiopathology</topic><topic>Myocardial Infarction - therapy</topic><topic>Pain</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vascular Patency</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brodie, Bruce R.</creatorcontrib><creatorcontrib>Stuckey, Thomas D.</creatorcontrib><creatorcontrib>Hansen, Charles</creatorcontrib><creatorcontrib>Muncy, Denise</creatorcontrib><creatorcontrib>Weintraub, Richard A.</creatorcontrib><creatorcontrib>LeBauer, E.Joseph</creatorcontrib><creatorcontrib>Kelly, Thomas A.</creatorcontrib><creatorcontrib>Katz, Jeffrey D.</creatorcontrib><creatorcontrib>Berry, Jonathan J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brodie, Bruce R.</au><au>Stuckey, Thomas D.</au><au>Hansen, Charles</au><au>Muncy, Denise</au><au>Weintraub, Richard A.</au><au>LeBauer, E.Joseph</au><au>Kelly, Thomas A.</au><au>Katz, Jeffrey D.</au><au>Berry, Jonathan J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Benefit of late coronary reperfusion in patients with acute myocardial infarction and persistent ischemic chest pain</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>1994-09-15</date><risdate>1994</risdate><volume>74</volume><issue>6</issue><spage>538</spage><epage>543</epage><pages>538-543</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>The benefit of thrombolytic therapy given late after the onset of acute myocardial infarction (AMI) has been controversial because of low reperfusion rates and limited myocardial salvage. Persistent chest pain has been used as a criteria for late intervention, but there is little documentation to validate this practice. Clinical outcomes and myocardial salvage were evaluated in 74 patients with AMI and persistent chest pain who underwent late reperfusion (>6 hours) with direct coronary angioplasty, and these were compared with outcomes in 460 patients with early reperfusion (≤6 hours). Patients with late reperfusion had a high infarct artery patency rate (96%), a low hospital mortality rate (5.4%), and a low incidence of reinfarction (1.4%) and recurrent ischemia that were similar to patients with early reperfusion. Patients with late reperfusion had surprisingly good recovery of left ventricular function with improvement in ejection fraction from 50% to 60% at follow-up angiography. Patients with late reperfusion had a greater incidence of collateral flow (45% vs 22%, p < 0.001) and a lower value of peak creatine kinase (1,357 vs 2,057 U/liter, p < 0.001) than patients with early reperfusion. This study emphasizes the importance of persistent chest pain as a marker of continued myocardial viability in patients who present late after AMI. These data suggest that the probable mechanism of continued viability is preserved flow to the infarct zone. Patients with AMI and persistent chest pain may benefit from reperfusion therapy beyond 6 to 12 hours.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>8074034</pmid><doi>10.1016/0002-9149(94)90740-4</doi><tpages>6</tpages></addata></record> |
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| ispartof | The American journal of cardiology, 1994-09, Vol.74 (6), p.538-543 |
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| subjects | Aged Angina Pectoris - mortality Angina Pectoris - physiopathology Angina Pectoris - therapy Angioplasty Angioplasty, Balloon, Coronary Biological and medical sciences Cardiology. Vascular system Cardiovascular disease Chi-Square Distribution Confounding Factors (Epidemiology) Coronary heart disease Drug therapy Female Heart Hospital Mortality Humans Male Medical research Medical sciences Middle Aged Myocardial Infarction - mortality Myocardial Infarction - physiopathology Myocardial Infarction - therapy Pain Recurrence Retrospective Studies Time Factors Treatment Outcome Vascular Patency Ventricular Function, Left |
| title | Benefit of late coronary reperfusion in patients with acute myocardial infarction and persistent ischemic chest pain |
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