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Keyword: reinfarction (3) 17 Jun 2020 Run
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Keyword: reinfarction (3)	17 Jun 2020	Run

Treatment of Reinfarction After Thrombolytic Therapy for Acute Myocardial Infarction : An Analysis of Outcome and Treatment Choices in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO I) and Assessment of the Safety of a New Thrombolytic (ASSENT 2) Studies
- Gabriel I. Barbash,
- Yochai Birnbaum,
- Kris Bogaerts,
- Michael Hudson,
- Emmanuel Lesaffre,
- Yuling Fu,
- Shaun Goodman,
- Katrijn Houbracken,
- Kurt Munsters,
- Chris B. Granger,
- Karen Pieper,
- Robert M. Califf,
- Eric J. Topol and
- Frans Van de Werf
Circulation Volume 103, Issue 7

Abstract PDF/EPUB

Abstract
Background—Early reinfarction after thrombolytic therapy is associated with adverse outcomes and increased mortality. Among patients with reinfarction in the 1992 Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO I) and the 1998 Assessment of the Safety of a New Thrombolytic (ASSENT 2) trials, we investigated temporal and regional differences in the use of repeat thrombolysis, revascularization (angioplasty and/or bypass surgery), or conservative measures and the outcomes of each management strategy.Methods and Results—Data from the 4% of patients (n=2301) who experienced reinfarction after thrombolytic therapy were studied. Baseline characteristics, 30-day mortality, and incidence of total and hemorrhagic strokes were compared among the 3 treatment groups. The 30-day mortality did not differ between the repeat thrombolysis and revascularization groups (P=0.72), and it was significantly lower among patients treated by these 2 strategies than in those treated conservatively (11% and 11% versus 28%, respectively; P<0.001). Stroke rates did not differ significantly between the 3 treatment strategies (P=0.49). From 1992 to 1998, the percentage of reinfarction patients treated with repeat thrombolysis decreased from 29.3% to 18.5% in US centers and from 51.4% to 41.9% in all other centers (P<0.001). In contrast, use of revascularization procedures increased from 33.5% to 47.9% in US centers and from 8.1% to 23.0% in all other centers (P<0.001).Conclusions—Repeat thrombolysis and revascularization are associated with significantly lower mortality among reinfarction patients. Randomized trials are necessary to assess the exact risks and benefits of rethrombolysis versus interventional revascularization in this subset of high-risk patients presenting with reinfarction after thrombolytic therapy.
Fourth Universal Definition of Myocardial Infarction (2018)
- Kristian Thygesen,
- Joseph S. Alpert,
- Allan S. Jaffe,
- Bernard R. Chaitman,
- Jeroen J. Bax,
- David A. Morrow,
- Harvey D. White and
Circulation Volume 138, Issue 20
Varying Definitions for Periprocedural Myocardial Infarction Alter Event Rates and Prognostic Implications
- Hanan Idris,
- Sidney Lo,
- Ibrahim M. Shugman,
- Yousef Saad,
- Andrew P. Hopkins,
- Christian Mussap,
- Dominic Leung,
- Liza Thomas,
- Craig P. Juergens and
- John K. French
Journal of the American Heart Association Volume 3, Issue 6

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Abstract
BackgroundPeriprocedural myocardial infarction (PMI) has had several definitions in the last decade, including the Society for Cardiovascular Angiography and Interventions (SCAI) definition, that requires marked biomarker elevations congruent with surgical PMI criteria.Methods and ResultsThe aim of this study was to examine the definition‐based frequencies of PMI and whether they influenced the reported association between PMI and increased rates of late death/ myocardial infarction (MI). We studied 742 patients; 492 (66%) had normal troponin T (TnT) levels and 250 (34%) had elevated, but stable or falling, TnT levels. PMI, using the 2007 and the 2012 universal definition, occurred in 172 (23.2%) and in 99 (13.3%) patients, respectively, whereas 19 (2.6%) met the SCAI PMI definition (P<0.0001). Among patients with PMI using the 2012 definition, occlusion of a side branch ≤1 mm occurred in 48 patients (48.5%) and was the most common angiographic finding for PMI. The rates of death/MI at 2 years in patients with, compared to those without, PMI was 14.7% versus 10.1% (P=0.087) based on the 2007 definition, 16.9% versus 10.3% (P=0.059) based on the 2012 definition, and 29.4% versus 10.7% (P=0.015) based on the SCAI definition.ConclusionIn this study, PMI, according to the SCAI definition, was associated with more‐frequent late death/MI, with ≈20% of all patients, who had PMI using the 2007 universal MI definition, not having SCAI‐defined PMI. Categorizing these latter patients as SCAI‐defined no PMI did not alter the rate of death/MI among no‐PMI patients.

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Fourth Universal Definition of Myocardial Infarction (2018)

Varying Definitions for Periprocedural Myocardial Infarction Alter Event Rates and Prognostic Implications

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