The NORwegian study on DIstrict treatment of ST-Elevation Myocardial Infarction (NORDISTEMI)
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Abstract:
Thrombolysis is the treatment of choice for patients with ST-elevation myocardial infarction (STEMI) living in rural areas with long transfer delays to percutaneous coronary intervention (PCI). This trial compares two different strategies following thrombolysis: to transfer all patients for immediate coronary angiography and intervention, or to manage the patients more conservatively.The NORwegian study on DIstrict treatment of STEMI (NORDISTEMI) is an open, prospective, randomized controlled trial in patients with STEMI of less than 6 hours of duration and more than 90 minutes expected time delay to PCI. A total of 266 patients will receive full-dose thrombolysis, preferably pre-hospital, and then be randomized to either strategy. Our primary endpoint is the one year combined incidence of death, reinfarction, stroke or new myocardial ischaemia. The study is registered with ClinicalTrials.gov, number NCT00161005.By April 2006, 109 patients have been randomized. Thrombolysis has been given pre-hospital to 52% of patients. The median transport distance from first medical contact to catheterization laboratory was 155 km (range 90-396 km). Results of the study are expected in 2008.Keywords:
Norwegian
Clinical endpoint
ST elevation
Stroke
Reperfusion therapy for STEMI includes primary PCI and thrombolysis.In China,only 12% STEMI patients could accept primary PCI in time.On the contrary,more than 50% percent patients had thrombolysis therapy,thus,thrombolysis play an important role in China.It was confirmed that Facility PCI was inferior to Primary PCI.Meantime thrombolysis was not the end point for STEMI patient.The recent medical evidence indicate that early transfer PCI after thrombolysis was good than rescue PCI.
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To assess the application status of transradial coronary angiography (TRA) and transradial coronary intervention (TRI) in China in 2007.From Feb 10th to Apr 30th 2008, investigating questionnaires of this study were sent to 450 hospitals in China to collect information on application of percutaneous coronary intervention (PCI) and TRI in these centers.One hundred and twelve questionnaires were received. A total of 115 142 coronary angiography (CAG) and 48 379 PCI were performed in these centers including 69 354 TRA (60.24%) and 27 227 TRI (56.28%). A total of 77 488 stents were implanted from 47 160 PCI (1.64 stents per PCI) and 93.98% implanted stents were drug-eluting stent. Total 9290 stents (86.95% drug-eluting stent) were implanted in 7140 primary PCI (1.30 stents per PCI).TRA and TRI have become the major approaches of CAG and PCI in China in 2007.
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Presentation (obstetrics)
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Key Points Patients undergoing percutaneous coronary intervention (PCI) in the state of Michigan have more comorbidities compared to patients undergoing PCI in the United Kingdom. While the adoption of radial artery access for PCI has increased steadily over time in both Michigan and the United Kingdom, the use of radial access was significantly greater in the UK at all time points compared to Michigan for all PCI indications. The use of mechanical support during PCI has increased over time in Michigan but decreased over time in the United Kingdom.
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Background— Radial access for percutaneous coronary intervention (r-PCI) is associated with reduced vascular complications; however, previous reports have shown that <2% of percutaneous coronary intervention (PCI) procedures in the United States are performed via the radial approach. Our aims were to evaluate temporal trends in r-PCI and compare procedural outcomes between r-PCI and transfemoral PCI. Methods and Results— We conducted a retrospective cohort study from the CathPCI registry (n=2 820 874 procedures from 1381 sites) between January 2007 and September 2012. Multivariable logistic regression models were used to evaluate the adjusted association between r-PCI and bleeding, vascular complications, and procedural success, using transfemoral PCI as the reference. Outcomes in high-risk subgroups such as age ≥75 years, women, and patients with acute coronary syndrome were also examined. The proportion of r-PCI procedures increased from 1.2% in quarter 1 2007 to 16.1% in quarter 3 2012 and accounted for 6.3% of total procedures from 2007 to 2012 (n=178 643). After multivariable adjustment, r-PCI use in the studied cohort of patients was associated with lower risk of bleeding (adjusted odds ratio, 0.51; 95% confidence interval, 0.49–0.54) and lower risk of vascular complications (adjusted odds ratio, 0.39; 95% confidence interval, 0.31–0.50) in comparison with transfemoral PCI. The reduction in bleeding and vascular complications was consistent across important subgroups of age, sex, and clinical presentation. Conclusions— There has been increasing adoption of r-PCI in the United States. Transradial PCI now accounts for 1 of 6 PCIs performed in contemporary clinical practice. In comparison with traditional femoral access, transradial PCI is associated with lower vascular and bleeding complication rates.
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In many patients, comparable results can be achieved either with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). The comparison of PCI versus CABG is frequently reported in randomised trials, national registries, multicentre collaborations and single-centre experiences. However, the patients included in these analyses are either highly selected (trials), or comprehensive (national registries and retrospective studies). Large registries differ from each other since indications for PCI or CABG may be different among geographic regions, hence the large PCI:CABG ratio variability that has been described. Some patients can only undergo bypass surgery because they have too complex coronary artery disease deemed unsuitable to be treated with PCI. In contrast, PCI can be the only treatment option if patients are deemed inoperable due to advanced age or severe co-morbidities. Separate analyses of these patients that are excluded from randomisation is needed to fully understand the strength, limitations and outcomes of PCI and CABG in selected patients. This review summarises the data of patients ineligible for randomisation and focuses specifically on the Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) PCI and CABG nested registries.
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Percutaneous coronary intervention (PCI) continues to advance at pace with an ever-broadening indication. In this article we will review the recent technological advances in PCI that have enabled more complex coronary disease to be treated. The choice of revascularisation strategy must take into account the evidence-just because we can treat by PCI does not necessarily mean we should. When PCI is indicated, a safe, precision PCI approach guided by physiology, imaging and optimal lesion preparation should be the goal to obtain complete revascularisation and a durable long-term result. When these standards are adhered to, the outcomes can be excellent, in even complex coronary disease. We provide contemporary trial evidence to justify PCI and treatment algorithms that ensure optimal revascularisation decision making to achieve the best patient outcomes.
Interventional cardiology
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Background: The use of radial access for percutaneous coronary intervention (r-PCI) is associated with reduced risk of bleeding complications and higher patient satisfaction. However, the use of r-PCI differs greatly by country and is unknown in China. We examined trends in the adoption of r-PCI in China over the past decade and identified factors associated with its use. Methods: We used a two-stage random sampling strategy to create a nationally representative sample of 5,462 patients undergoing percutaneous coronary intervention (PCI) in China in 2001 (n=402; 24 sites), 2006 (n=1,390; 44 sites), and 2011 (n=3,670; 54 sites). We calculated the weighted proportion of patients receiving r-PCI in each time period and conducted multivariable analysis to identify the patient and hospital characteristics associated with not receiving r-PCI in 2011. Results: Among 5,462 patients who underwent PCI, the use of r-PCI increased markedly over time (2001: 3.4% [95% CI 0.0%-8.5%]; 2006: 36.5% [95% CI 34.2%-38.9%], 2011: 74.7% [95% CI 73.9-75.6]; P for trend <0.001). Increases in r-PCI use were widespread, including high-risk subgroups such as the elderly, women, and patients with acute coronary syndromes (Figure). In multivariable analysis of 3,670 patients undergoing PCI in 2011, cardiogenic shock and emergency PCI were strongly associated with failure to use r-PCI in 2011. Conclusion: Over a recent ten-year period, radial access became the predominant strategy for PCI in China, even among high-risk patients. This study demonstrates the responsiveness of the interventional cardiology community to emerging evidence. A deeper understanding of the factors facilitating r-PCI adoption in China may help increase its usage in countries in which r-PCI use remains low.
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