And, prehospital fibrinolysis with timely angiography effective for reperfusion in STEMI
MONDAY, March 11 (HealthDay News) -- In primary percutaneous coronary intervention (PCI), cangrelor correlates with reduced ischemic events; and, prehospital fibrinolysis with timely angiography is effective for reperfusion in patients unable to undergo primary PCI within one hour after ST-segment elevation myocardial infarction (STEMI), according to two studies published online March 10 in the New England Journal of Medicine to coincide with presentation at the annual meeting of the American College of Cardiology, held from March 9 to 11 in San Francisco.
Deepak L. Bhatt, M.D., M.P.H., from the VA Boston Healthcare System, and colleagues randomized 11,145 patients undergoing urgent or elective PCI to receive cangrelor or clopidogrel. The researchers found that the rate of the primary efficacy end point (composite of death, myocardial infarction, ischemia-driven revascularization, or stent thrombosis) was significantly lower with cangrelor. Stent thrombosis was significantly reduced at 48 hours with cangrelor. There was no between-group difference in the rate of severe bleeding at 48 hours.
Paul W. Armstrong, M.D., from the University of Alberta in Edmonton, Canada, and colleagues randomized 1,892 patients with STEMI who were unable to undergo primary PCI within one hour to undergo primary PCI or fibrinolytic therapy followed by coronary angiography. The researchers observed no significant difference in the occurrence of the primary end point (composite of death, shock, congestive heart failure, or reinfarction up to 30 days) between the groups (P = 0.21), but there were significantly more intracranial hemorrhages in the fibrinolysis group.
"Prehospital fibrinolysis with timely coronary angiography resulted in effective reperfusion in patients with early STEMI who could not undergo primary PCI within one hour after first medical contact," Armstrong and colleagues write.
The Bhatt study was supported by The Medicines Company, the manufacturer of cangrelor. Several authors from the Armstrong study disclosed financial ties to the pharmaceutical industry, including Boehringer Ingelheim, which funded the study.
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Abstract - Armstrong
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