Main Data
Author: James E. Tcheng
Editor: James Tcheng
Title: Primary Angioplasty in Acute Myocardial Infarction
Publisher: Humana Press
ISBN/ISSN: 9781603274975
Edition: 2
Price: CHF 154.70
Publication date: 01/01/2009
Category: Medizin & Pharmazie
Language: English
Technical Data
Pages: 225
Kopierschutz: DRM
Geräte: PC/MAC/eReader/Tablet
Formate: PDF
Table of contents
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.
Table of contents
Overview, Rationale, and Lexicon: Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction12
Comparison of Reperfusion Strategies for ST Elevation Acute Myocardial Infarction: Primary Coronary Intervention Versus Fibrinolysis20
Historical Background20
Comparison of Clinical Outcomes21
Clinical Outcomes from Randomized Trials21
Clinical Outcomes from Registries23
Comparison of Angiographic Outcomes and Myocardial Salvage25
Angiographic Outcomes25
Myocardial Salvage26
ACC/AHA and ESC Guidelines for Reperfusion in STEMI27
Fibrinolysis Versus Transfer for Primary PCI in Patients Presenting to Non-PCI Hospitals28
Primary PCI as a Reperfusion Strategy30
Operator and Site Requirements for Primary Coronary Intervention37
General Considerations38
Prehospital Phase38
Staffing Issues39
Pharmacological Requirements40
Operator and Institutional Requirements41
Requirement for On-site Surgical Backup44
Primary PCI: Community Versus Tertiary Care Hospital48
The Case for Community Hospital Primary PCI48
The Case for Transfer to a Tertiary Care Hospital for Primary PCI49
Performance Improvement: Strategies for Decreasing Door to Balloon Times50
Quality Assurance: Audit and Peer Review51
Primary Coronary Intervention: The Technical Approach57
Initial Contact57
Pre-Procedure Evaluation58
Entry into the Catheterization Laboratory59
Coronary Angiography60
Crossing the Lesion60
Coronary Intervention62
Multilesion PCI During Primary Angioplasty64
Arrhythmia Management65
Mechanical Complications of Infarction and Intervention65
Thrombotic Complications66
Alternative Devices68
Primary Coronary Intervention in Community Hospitals with Off-Site Cardiac Surgery Backup: Rationale and Steps to Quality74
Primary Coronary Intervention at Hospitals Without Cardiac Surgery: Role and Rationale74
Justification for Primary Coronary Intervention Programs in Hospitals Without Cardiac Surgery76
Key Program Elements for Hospitals Considering Primary Pci with Off-Site Cardiac Surgery Backup79
Interdisciplinary Acute Myocardial Infarction Quality Improvement Team79
Primary PCI Care Plans81
Ongoing Interdisciplinary Efforts to Reduce D2B Times84
Reducing System and Process Barriers: The RACE to Improve Door to Balloon Performance93
Systematic Barriers to Care93
Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments94
Funding, Leadership, and Oversight95
Organization and Development96
Implementation and Interventions99
Rescue Coronary Intervention for Failed Thrombolysis108
Technical considerations109
Key clinical factors supporting the rescue angioplasty approach110
The evidence behind rescue PCI111
Observational studies and retrospective subgroup analyses111
Randomized Clinical Trials111
Role of Delayed PCI in patients with ST-segment elevation MI116
Facilitated Percutaneous Coronary Intervention121
Fibrinolysis-Facilitated PCI122
Fibrinolysis Alone122
Reduced-Dose Fibrinolysis with Glycoprotein IIb/IIIa Inhibitors125
Non-Fibrinolysis-Facilitated PCI127
High Dose Heparin127
Glycoprotein IIb/IIIa Receptor Antagonists128
Discussion and Conclusions132
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 Interven121
Therapies Targeted at Preserving Microvascular Integrity and Preventing Reperfusion Injury140
Microvascular Obstruction and Reperfusion Injury140
Imaging Microvascular Obstruction142
Clinical Management of No Reflow143
Endothelium-Independent Vasodilators145
Calcium Channel Blockers148
Anticoagulants, Platelet Inhibitors, and Thromobolytics150
Unfractionated Heparin150
Thrombolytic Drugs with Primary PCI151
GP IIb/IIIa Inhibitors151
Other Drugs and Experimental Strategies154
ATP-sensitive Potassium Channel Openers: Nicorandil and Diazoxide155
Agents for Direct Myocardial Protection: Cariporide and Trimetazidine156