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KMID : 1100320170340020191
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Yeungnam University Journal of Medicine
2017 Volume.34 No. 2 p.191 ~ p.199
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Long-term clinical outcome of acute myocardial infarction according to the early revascularization method: a comparison of primary percutaneous coronary interventions and fibrinolysis followed by routine invasive treatment
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Min Hyang-Ki
Park Ji-Young
Choi Jae-Woong
Ryu Sung-Kee
Kim Seung-Hwan
Song Chang-Sup
Kim Dong-Shin
Song Chi-Woo
Kim Se-Jong
Kim Young-Bin
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Abstract
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Background: This study was conducted to provide a comparison between the clinical outcomes of primary percutaneous coronary intervention (PCI) and that of fibrinolysis followed by routine invasive treatment in ST elevation myocardial infarction (STEMI).
Methods: A total of 184 consecutive STEMI patients who underwent primary PCI or fibrinolysis followed by a routine invasive therapy were enrolled from 2004 to 2011, and their major adverse cardiovascular events (MACEs) were compared.
Results: Among the 184 patients, 146 patients received primary PCI and 38 patients received fibrinolysis. The baseline clinical characteristics were similar between both groups, except for triglyceride level (68.1±66.62 vs. 141.6±154.3 mg/dL, p=0.007) and high density lipoprotein level (44.6±10.3 vs. 39.5±8.1 mg/dL, p=0.005). The initial creatine kinase-MB level was higher in the primary PCI group (71.5±114.2 vs. 35.9±59.9 ng/mL, p=0.010). The proportion of pre-thrombolysis in MI 0 to 2 flow lesions (92.9% vs. 73.0%, p<0.001) was higher and glycoprotein IIb/IIIa inhibitors were administered more frequently in the primary PCI group. There was no difference in the 12-month clinical outcomes, including all-cause mortality (9.9% vs. 8.8%, p=0.896), cardiac death (7.8% vs. 5.9%, p=0.845), non-fatal MI (1.4% vs. 2.9%, p=0.539), target lesion revascularization (5.7% vs. 2.9%, p=0.517), and stroke (0% vs. 0%). The MACEs free survival rate was similar for both groups (odds ratio, 0.792; 95% confidence interval, 0.317?1.980; p=0.618). The clinical outcome of thrombolysis was not inferior, even when compared with primary PCI performed within 90 minutes.
Conclusion: Early fibrinolysis with optimal antiplatelet and antithrombotic therapy followed by appropriate invasive procedure would be a comparable alternative to treatment of MI, especially in cases of shorter-symptom-to-door time.
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KEYWORD
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Fibrinolysis, Percutaneous coronary intervention, Myocardial infarction
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