A short door-to-balloon time (D2B) is considered a quality of care measure for patients of ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous intervention (pPCI). However, recent literature has documented reductions in D2B that were not associated with improved STEMI mortality. Using the National Cardiovascular Data Registry (NCDR) CathPCI Registry, Nallamothu et al. assessed this apparent […]
Tag: STEMI
No benefit to thrombus aspiration in STEMI
Thrombus aspiration in acute ST-segment elevation myocardial infarction (STEMI) is clinically appealing and often used prior to PCI. However, the majority of trials evaluating thrombus aspiration have failed to demonstrate significant mortality benefit. The Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial is a multi-center study that randomized a total of 7244 presenting […]
Thrombus aspiration in STEMI fails to demonstrate benefit
Thrombus aspiration during primary PCI for patients presenting with ST elevation myocardial infarction (STEMI) is an intuitively attractive manoeuvre to aid rapid reperfusion, reduce distal embolization and improve microvascular perfusion. Despite limited trial evidence of clinical benefit, the procedure has quickly taken hold in many PCI centres with European and US guidelines agreeing on a […]
Bivalirudin in contemporary STEMI treatment
The novel direct thrombin inhibitor bivalirudin is now widely used as an adjunctive therapy in patients undergoing primary PCI for ST elevation myocardial infarction (STEMI). This stems from trial data demonstrating bivalirudin results in lower bleeding rates and better long term survival as compared with the combination of heparin and a GP IIb/IIIa inhibitor. However, […]
Treatment of bystander coronary disease in primary PCI improves outcomes
In patients with ST-elevation myocardial infarction (STEMI), current guidelines support PCI of the infarct related artery and medical management of flow-limiting lesions in non-infarct related vessels (so-called bystander disease). This paradigm is challenged in the Preventive Angioplasty in Acute Myocardial Infarction (PRAMI) study. In this single-blind trial performed at five UK centres, patients presenting with […]
COMFORTABLE AMI: New-generation DES shows benefit
Drug-eluting stents (DES) with biodegradable polymers can allow controlled drug release followed by subsequent degradation of the polymer, leaving a in essence a bare-metal stent. In patients undergoing primary percutaneous coronary intervention (PCI) for acute ST-elevation myocardial infarction (STEMI), this may prevent the delayed vessel healing that is thought to be caused at least in […]
Intracoronary abciximab offers no extra benefit
Despite the introduction of primary angioplasty programmes for patients with acute ST-elevation myocardial infarction (STEMI), up to 70% of patients have impaired myocardial tissue perfusion even after successful treatment. As intracoronary delivery of abciximab results in much higher concentrations within the coronary artery when compared to intravenous administration, it is logical to propose that this […]
Use of evidence-based treatments improves STEMI outcomes
Over the last two decades several new treatments, both pharmacological and mechanical, have become available for the treatment of ST-elevation myocardial infarction (STEMI). As a result, several rounds of national and international guidelines have been developed to guide the implementation of these evidence-based treatments in clinical practice. However, relatively few data are available on how […]
Paclitaxel Stents Safe in STEMI
The Harmonising Outcomes with Revascularisation and Stents in Acute Myocardial Infarction (HORIZONS-AMI) was a prospective open label, multi-centre controlled trial involving patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). It incorporated two factorial randomised phases to allow a comparison of the direct thrombin inhibitor bivalirudin alone with heparin plus glycoprotein IIb-IIIa […]
Prasugrel proves powerful in STEMI
Prasugrel is novel third-generation thienopyridine which is a more potent blocker of the platelet P2Y12 receptor than clopidogrel.The TRITON-TIMI 38 (Trial to assess Improvement in Therapeutic Outcomes by optimizing platelet inhibition with prasugrel – Thrombolysis in Myocardial Infarction 38) study compared clopidogrel with prasugrel in the setting of ST elevation myocardial infarction (STEMI). […]