Differences in outcome of primary angioplasty for acute myocardial infarction during routine duty hours versus during off-hours: Is it the patient of is it care?

JACC

March 19,2003

to compare

flnal thrombus

vs. Percusurge

groups.

ABSTRACTS

scores

Results:

and CTFC The mean

results

between

initial CTFC

unprotected

vs. Angiojet

reduce macro and micro embolization

stenting

sion. We thought

in the unprotected

vs.

to elucidate

of debris, potentially

the effects on myocardial

improving

myocardial

repelfusion

bectomy as adjunct to coronary stentlng in the setting of direct angloplasty Methods: 92 patients with acute myocardial infarction and angiographic

+/- 19.3). the difference

intraluminal

significant

(p=O.55).

However,

comparison

thrombus

were randomized

to coronary

thrombectomy

followed

thrombus

stenosis,

group (3.9 +/- 1.0 vs. 4.4 +/- 0.86, p
AMI percutaneous

intervention

improves

the fInal CTFC. This correlates

in-hospital and long term mortality. We, therefore, in more thrombus burdened AMI stenting.

recommend

was

groups during

with decreased

the use of distal protection

minimal

Results:

Baseline

David E. Kandzarl, Eulogio

James E. Tcheng,

Thomas

D. Stuckey,

Modest-sized

as adjunctive

therapy

trials examining

in primary

the benefit of glycoprotein

percutaneous

coronary

strated improved early cllnical and angiographic sample size. and late outcomes have precluded Methods

We performed

a two-way

intervention

Despite

similar

baseline

comparison

cllnical

IlbAlla

Institute,

Inhibition

(PCI) have demon-

of early and late outcomes

and angiographic

characteristics,

or disabling

stroke (7.0% vs. 4.8%

abcx treat-

OR 1.54, 95% Cl, 1.08 to 2.19, p=O.Ol).

patients randomized to abcx, TIMI 3 flow tended to be greater at baseline (20.3% vs. 23.8%, p=O.O6), and was more frequently present post-procedure sus 96.5%,

p=O.O3). Severe

bleeding

was not increased

with abcx.

In

prior to abcx (94.8% ver-

30.day

aroup

versus

and distal

according compared

characteristics

(Myocardial

were similar between

Blush groups.

patients

versus

17 of 46 (36.9%)

(p=O.O06).

to ECG criteria, post-procedural ST-segment elevato baseline in 27 of 46 patients (58.7%) of throm-

15 of 46 (32.6%)

subacute

embolizations

of arow

in patients

p=O.O6 respectively). By multivarlate predictor of Blush-3 (p= 0.001). Conclusions:

lntracoronary

dial repeiiwon

as assessed

aswaned

to conventional

strateav.

not underwent

analysis

thrombectomy

the use of X-Sizer

(p=O.O9 and

was an independent

thrombectomy

during

by myocardial

blush grade and ST-segment

direct angioplasty

improves

myocar-

resolution.

Impact of Multivessel Coronary Artery Disease on InHospital Outcome in Patients Treated by Immediate Angioplasty for Acute Myocardial Infarction

1097-98

to abcix-

ment was associated with a signlflcant reduction in the 30-day occurrence of death (D), repeat myocardial Infarction (reMI), ischemia-driven target vessel revascularization (TVR),

who did not: 33 of 46 (71.7%)

for 2,082

who were randomized

and after the proce-

,

reflow

outcomes. yet variability in trial design, these studies from being definitive.

AMI patients undergoing primary PCI (PTCA or stenting) imab (abcx. 1x1052) or control (n=1030). Results

Research

at baseline

to angiographic

regressed> 56% in 11 (23.9%) versus 9 il9.8;). and remained unchanged in 8 (17.4%) versus 22 oatients (47.8%) resoectivelv fo=O.OOl).There was a trend toward more no-

Mark Turco.

Alexandra J. Lansky, Roxana Mehran, Gregg W. Stone, Duke Clinical Durham, NC, Cardiovascular Research Foundation. New York, NY Background

bectomv

Cindy L. Grines, Mark Effron, David A. Cox,

Garcia, John J. Griffin, Giulio Guagliuml,

clinical and angiographic

Assessing the reperfusion tion appeared normalized

Benefits and Risks of Abciximab Use in Primary Angioplasty for Acute Myocardial Infarction: The CADILLAC Trial

(MLD) were assessed

using the diameter

Postprocedural TIMI flow, MLD and diameter stenosis were not different between groups (p=ns). The blush 3 was observed more often in patients underwent thrombectomy than in patlent

1097-95

lumen diameter

dure. Myocardial repeffusion was assessed according Grade) and ECG criteria (ST segment resolution).

of

by stenting

(46 patients) or to stenting alone (46 patients). Thrombectomy was performed X-Sizer catheter (EndiCOR Inc. San Clemente. CA, USA). TIMI flow grade,

than the unprotected

throm-

for AMI. evidence

between the final CTFC in the Percusurge group and the unprotected group was statistically significant (17.f +/- 6.2 vs. 27.6 +i- 19.3, pzO.02). The Angiojet group had less no significant difference in thrombus scores in the Percusurge and unprotected (4.6 +/- 0.78 vs. 4.4 +I- 0.86, ~~0.3). Conclusions: The use of distal protection

tepedu-

of mechanical

Angiojet vs. Percusurge groups was 83.8, 72.5, and 90.8 respectively. Although the mean final Angiojet CTFC was lower than the unprotected group (25.8 +/- 13.4 vs. 27.6 was not statistically

357A

- Myocardial Ischemia and Infarction

Tadeusz Zebik, Marek Gierlotka, Krzysztof Wilczek, Przemyslaw Trzeciak. Marwsz Gasior, Janusz Szkodzinski, Rafal Wojnar, Marek Kondys, Andrzej Lekston, Tomasz Niklewskl,

Krzysztof

Dyrbus.

Jaroslaw

Wasilewski,

Heart Disease, Silesian School of Medicine,

Lech Polonski,

Zabrze,

Silesian

Centre for

Poland

Background. The aim of the study was to analyze in-hospital outcome of patients (pts) with acute myocardial infarction (AMI) treated by immediate angioplasty (PCI) with and wlthout

other significant

stenoses

in non-infarct

related artery.

thrombosis rates were also reduced by abcx (1.5% vs. 0.4%. p=O.Ol). By 12 months. abcx was no longer associated with significant differences in the composite endpoint

Methods A total of 970 consecutive pts with AMI (77% male, mean age 57.0*11.2 years) treated by immediate PCI were compared, according to coronary angiography, in

(18.4% for controls

the two groups:

vs. 16.9% for abcx. p=O.29). Myocardial

salvage,

angiographic

rest-

enosis, and infarct artery reocclusion at 7.month follow-up angiography were unaffected by abcx treatment. Although the absolute difference in ischemic TVR rates between the two groups

persisted

at 1 year, the relative difference

was no longer statistically

cant, in part due the lack of influence by abcx on restenosis cularlzation procedures. No significant Interaction between

slgnifi-

and accrual of repeat revascoronary stenting and abcx

the SINGLE

group

(456 pts without

MULTI group (514 pts with multivessel tered before PCI to 378 (39%) of pts.

disease).

other

stenoses

Thrombolytlc

Results In MULTI group pts were older (59.5klO.9

>50%)

treatment

vs. 54.2ill.O

and the

was adminis-

years

in SINGLE

group, p
was observed.

(56.8% vs. 43.2%. pcO.0001)

Conclusions Abciximab treatment, when administered just prior to intervention as adjunctive therapy to primary PCI, is associated with significant reductions in early

quent, whereas smoking (60.2% vs. 68.4%. p=O.O078) and anterior locatlon (35.6% vs. 50.0% p
adverse outcomes. treatment year.

In spite of an overall early reduction

does not significantly

influence

in the composite

the occurrence

Jose P. Henriaues, Weezenlanden. Background:

Amout

Zwolle,

P. Haasdijk,

Felix Zijlstra. lsala Klinleken,

A circadvan variation

and results: We studied

1702 consecutive

patterns

of symptom-onset,

primary hospital

hospital

hours and off-hours

clinical

characteristics

patients.

ated with an angioplasty

Hospital

failure

08.00. pcO.01. Thirty day mortality 08.00 and 18.00, compared and 08.00, p
Cwzadian

and balloon

Massimo

inflation

or treatment

admlssion

delays

between

rate of 3.8%, compared

between

routine

duty

08.00 and 18.00 was associto 6.9% between

was 1.9% in patients wth hospital with hospital

Napodano,

may have a profound

treated during

twue

TIMI 2 or 3 flow

Reimers,

Pletro Pascotto,

Giampaolo

18.00

effect on the practice of pnmary

repedusion.

Pasquetto,

Mirano Hospital,

Patients treated during worse clinical outcome,

Mechanical

Salvatore

Mirano.

SaccB, Cario

Italy

debris during angioplasty for acute in the microvascular system, caus-

intracoronaly

thrombectomy

outcome

compared

is presented

to 7% III SINGLE

MULTI

SINGLE

514 (53%)

456 (47%)

P value

33.1 %

38.2 %

Final TIMI 3 flow

89.1 %

91.5 %

0.22

Stent implantation

51.4 %

59.2 %

0.014

Ejection fraction

43.3t8.4

45.7+7.8


Reocclus~on

7.0 %

4.8 %

0.15

Bypass surgery

8.4 %

0.4 %

<0.0001

In-hospital

8.0 %

2.6 %

0.0003

111437 (2.5%)

4/424 (0.9%)

0.078

30/77 (39%)

8/32 (25%)

0.16

mortality

Pts without

CS on admission

Pts with CS on admlssion

group.

!n the table.

0.099

between

between

routine duty hours.

Background. Embolizatlon of thrombus and plaque myocardlal Infarction (AMI) may lead to obstructions ing suboptimal

N (%)

Conclusion Despite similar effectiveness ease have worse in-hospital

Bernhard

lvano Dell’Olivo,

in 15% of pts in MULTI

and in-hospital

p
18.00 and

admission

admission

was present

are simi-

lntracoronary Thrombectomy Improves Myocardial Reperfusion in Patients Undergoing Direct Angioplasty: A Single-Center Randomized Study

1097-97

Cemetti.

ele-

(53%), hospital admission (53%) and first hours (OS.OO-18.OOh). There were no dif-

to 4.2% in patients

variations

to patients

the impact of

with acute ST segment

angioplasty. A majority of patients is treated during the daytime. off-hours have a more often failed angioplasty and consequently when compared

with

angioplasty. We observed circadian admission, and first balloon inflation.

admission

lar. A majority of patients have symptom-onset balloon inflation (52%) during daytime working in baseline

patients

infarction

to investigate

admission

p
Baseline

Locatie

in the time of onset of acute myocardral

vation myocardial Infarction treated with variation in frequency of symptom-onset,

ferences

at 1

The Netherlands

a peak I” the morning hours has been described. We sought circadian patterns on the practice of primary angioplasty.

Circadian

abcx

Differences in Outcome of Primary Angioplasty for Acute Myocardial Infarction During Routine Duty Hours Versus During Off-Hours: Is It the Patient or Is It Care?

1097-96

Methods

endpoint,

of D. reMI, or restenosis

and prior Ml (29.4% vs. lO.i%,

is thought

to

cardiogenic

outcome.

shock on admission.

of PCI, patients with AMI and multwessel disOne of the reasons for that is higher incidence of