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Eric R Bates - One of the best experts on this subject based on the ideXlab platform.
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response to letter regarding article evolution from Fibrinolytic Therapy to a Fibrinolytic strategy for patients with st segment elevation myocardial infarction
Circulation, 2015Co-Authors: Eric R BatesAbstract:I thank Drs Weiss and Gotsman for their interest in my editorial and respectfully acknowledge their pioneering work on prehospital Fibrinolytic Therapy. The potential benefit of prehospital compared with in-hospital Fibrinolytic Therapy was nicely demonstrated in a meta-analysis of 6 randomized, clinical trials including 6434 patients with ST-elevation–elevation myocardial infarction.1 Prehospital Therapy produced a 17% relative risk reduction and 2% absolute risk reduction for in-hospital mortality (odds ratio, 0.83; 95% confidence interval, 0.70–0.98; P =0.03). Additionally, a retrospective substudy analysis including 596 patients from 2 randomized, clinical trials suggested a 1-year mortality advantage for prehospital Fibrinolytic Therapy compared with primary percutaneous coronary …
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Response to Letter Regarding Article, “Evolution From Fibrinolytic Therapy to a Fibrinolytic Strategy for Patients With ST-Segment–Elevation Myocardial Infarction”
Circulation, 2015Co-Authors: Eric R BatesAbstract:I thank Drs Weiss and Gotsman for their interest in my editorial and respectfully acknowledge their pioneering work on prehospital Fibrinolytic Therapy. The potential benefit of prehospital compared with in-hospital Fibrinolytic Therapy was nicely demonstrated in a meta-analysis of 6 randomized, clinical trials including 6434 patients with ST-elevation–elevation myocardial infarction.1 Prehospital Therapy produced a 17% relative risk reduction and 2% absolute risk reduction for in-hospital mortality (odds ratio, 0.83; 95% confidence interval, 0.70–0.98; P =0.03). Additionally, a retrospective substudy analysis including 596 patients from 2 randomized, clinical trials suggested a 1-year mortality advantage for prehospital Fibrinolytic Therapy compared with primary percutaneous coronary …
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evolution from Fibrinolytic Therapy to a Fibrinolytic strategy for patients with st segment elevation myocardial infarction
Circulation, 2014Co-Authors: Eric R BatesAbstract:Placebo-controlled trials with Fibrinolytic agents first demonstrated important reductions in morbidity and mortality when reperfusion Therapy was administered to patients with ST-segment–elevation myocardial infarction (STEMI).1,2 Although primary percutaneous coronary intervention (PCI) is a better reperfusion strategy when compared with Fibrinolytic Therapy in randomized clinical trials,3 geographic access and logistical delays in time-to-treatment may decrease some of the benefits of primary PCI in clinical practice.4 Patients in the comparative trials were selected for randomization, delays to primary PCI were short, differences between treatments were magnified by the inclusion of studies with streptokinase, bleeding and intracerebral hemorrhage (ICH) rates with fibrinolysis may have been increased by higher anticoagulation targets than are now used, and reinfarction rates after fibrinolysis may have been higher than in the current era where clopidogrel and enoxaparin have shown benefit.5–7 Most importantly, Fibrinolytic Therapy was tested as monoTherapy, with crossover to rescue PCI or the early invasive strategy discouraged by most protocols. In contrast, national registry reports including a broader spectrum of patients, time delays, interventional cardiologists, and hospitals have shown no difference in mortality rates between primary PCI and Fibrinolytic Therapy coupled with early coronary angiography.8,9 Thus, the Fibrinolytic strategy that includes timely coronary angiography, and is now recommended by practice guidelines, is different from the Fibrinolytic Therapy that was tested years ago against placebo or primary PCI.10,11 Article see p 1139 The best current Fibrinolytic strategy may include the combination of bolus tenecteplase,12 aspirin,2 clopidogrel,5,6 and enoxaparin7 as initial Therapy. Clopidogrel is recommended because prasugrel and ticagrelor have not been tested with Fibrinolytic Therapy. These agents facilitate prehospital treatment13 and improve outcomes in patients with …
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Evolution From Fibrinolytic Therapy to a Fibrinolytic Strategy for Patients With ST-Segment–Elevation Myocardial Infarction
Circulation, 2014Co-Authors: Eric R BatesAbstract:Placebo-controlled trials with Fibrinolytic agents first demonstrated important reductions in morbidity and mortality when reperfusion Therapy was administered to patients with ST-segment–elevation myocardial infarction (STEMI).1,2 Although primary percutaneous coronary intervention (PCI) is a better reperfusion strategy when compared with Fibrinolytic Therapy in randomized clinical trials,3 geographic access and logistical delays in time-to-treatment may decrease some of the benefits of primary PCI in clinical practice.4 Patients in the comparative trials were selected for randomization, delays to primary PCI were short, differences between treatments were magnified by the inclusion of studies with streptokinase, bleeding and intracerebral hemorrhage (ICH) rates with fibrinolysis may have been increased by higher anticoagulation targets than are now used, and reinfarction rates after fibrinolysis may have been higher than in the current era where clopidogrel and enoxaparin have shown benefit.5–7 Most importantly, Fibrinolytic Therapy was tested as monoTherapy, with crossover to rescue PCI or the early invasive strategy discouraged by most protocols. In contrast, national registry reports including a broader spectrum of patients, time delays, interventional cardiologists, and hospitals have shown no difference in mortality rates between primary PCI and Fibrinolytic Therapy coupled with early coronary angiography.8,9 Thus, the Fibrinolytic strategy that includes timely coronary angiography, and is now recommended by practice guidelines, is different from the Fibrinolytic Therapy that was tested years ago against placebo or primary PCI.10,11 Article see p 1139 The best current Fibrinolytic strategy may include the combination of bolus tenecteplase,12 aspirin,2 clopidogrel,5,6 and enoxaparin7 as initial Therapy. Clopidogrel is recommended because prasugrel and ticagrelor have not been tested with Fibrinolytic Therapy. These agents facilitate prehospital treatment13 and improve outcomes in patients with …
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percutaneous coronary intervention versus Fibrinolytic Therapy in acute myocardial infarction is timing almost everything
American Journal of Cardiology, 2003Co-Authors: Brahmajee K Nallamothu, Eric R BatesAbstract:The mortality benefit associated with primary percutaneous coronary intervention in ST-segment elevation myocardial infarction may be lost if door-to-balloon time is delayed by >1 hour as compared with Fibrinolytic Therapy door-to-needle time. Interventional cardiology laboratories endeavoring to achieve the benefits of primary percutaneous coronary intervention seen in randomized clinical trials should aim to match their short door-to-balloon times.
Lixin Jiang - One of the best experts on this subject based on the ideXlab platform.
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ticagrelor versus clopidogrel in patients with stemi treated with Fibrinolytic Therapy treat trial
Journal of the American College of Cardiology, 2019Co-Authors: Otavio Berwanger, Renato D Lopes, Diogo D F Moia, Francisco Antonio Helfenstein Fonseca, Lixin Jiang, Shaun G Goodman, Stephen J Nicholls, Alexander ParkhomenkoAbstract:Abstract Background The efficacy of ticagrelor in the long-term post ST-elevation myocardial infarction (STEMI) treated with Fibrinolytic Therapy remains uncertain. Objectives To evaluate the efficacy of ticagrelor when compared with clopidogrel in STEMI patients treated with Fibrinolytic Therapy. Methods We conducted an international, multicenter, randomized, open-label with blinded endpoint adjudication trial that enrolled 3,799 patients (age Results The combined outcome of cardiovascular mortality, myocardial infarction or stroke occurred in 129 of 1,913 patients (6.7%) receiving ticagrelor and in 137 of 1,886 patients (7.3%) receiving clopidogrel (hazard ratio of 0.93; 95% CI, 0.73 to 1.18; P=0.53). The composite of cardiovascular mortality, myocardial infarction, stroke, severe recurrent ischemia, transient ischemic attack, or other arterial thrombotic events occurred in 153 of 1,913 patients (8.0%) treated with ticagrelor and in 171 of 1,886 patients (9.1%) receiving clopidogrel (hazard ratio of 0.88; 95% CI, 0.71 to 1.09; P=0.25). The rates of major, fatal, and intracranial bleeding were similar between the ticagrelor and clopidogrel groups. Conclusions Among patients aged under 75 years with STEMI, administration of ticagrelor after Fibrinolytic Therapy did not significantly reduce the frequency of cardiovascular events when compared with clopidogrel.
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ticagrelor vs clopidogrel after Fibrinolytic Therapy in patients with st elevation myocardial infarction a randomized clinical trial
JAMA Cardiology, 2018Co-Authors: Otavio Berwanger, Lixin Jiang, Shaun G Goodman, Stephen J Nicholls, Alexander Parkhomenko, Antonio Carlos Carvalho, Jose C Nicolau, Oleg Averkov, Carlos Tajer, German MalagaAbstract:Importance The bleeding safety of ticagrelor in patients with ST-elevation myocardial infarction treated with Fibrinolytic Therapy remains uncertain. Objective To evaluate the short-term safety of ticagrelor when compared with clopidogrel in patients with ST-elevation myocardial infarction treated with Fibrinolytic Therapy. Design, Setting and Participants We conducted a multicenter, randomized, open-label with blinded end point adjudication trial that enrolled 3799 patients (younger than 75 years) with ST-segment elevation myocardial infarction receiving Fibrinolytic Therapy in 152 sites from 10 countries from November 2015 through November 2017. The prespecified upper boundary for noninferiority for bleeding was an absolute margin of 1.0%. Interventions Patients were randomized to ticagrelor (180-mg loading dose, 90 mg twice daily thereafter) or clopidogrel (300-mg to 600-mg loading dose, 75 mg daily thereafter). Patients were randomized with a median of 11.4 hours after fibrinolysis, and 90% were pretreated with clopidogrel. Main Outcomes and Measures The primary outcome was thrombolysis in myocardial infarction (TIMI) major bleeding through 30 days. Results The mean (SD) age was 58.0 (9.5) years, 2928 of 3799 patients (77.1%) were men, and 2177 of 3799 patients (57.3%) were white. At 30 days, TIMI major bleeding had occurred in 14 of 1913 patients (0.73%) receiving ticagrelor and in 13 of 1886 patients (0.69%) receiving clopidogrel (absolute difference, 0.04%; 95% CI, −0.49% to 0.58%; P P = .001 for noninferiority). The rates of fatal (0.16% vs 0.11%; P = .67) and intracranial bleeding (0.42% vs 0.37%; P = .82) were similar between the ticagrelor and clopidogrel groups, respectively. Minor and minimal bleeding were more common with ticagrelor than with clopidogrel. The composite of death from vascular causes, myocardial infarction, or stroke occurred in 76 patients (4.0%) treated with ticagrelor and in 82 patients (4.3%) receiving clopidogrel (hazard ratio, 0.91; 95% CI, 0.67-1.25; P = .57). Conclusions and Relevance In patients younger than 75 years with ST-segment elevation myocardial infarction, delayed administration of ticagrelor after Fibrinolytic Therapy was noninferior to clopidogrel for TIMI major bleeding at 30 days. Trial Registration clinicaltrials.gov Identifier:NCT02298088
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china peace risk estimation tool for in hospital death from acute myocardial infarction an early risk classification tree for decisions about Fibrinolytic Therapy
BMJ Open, 2016Co-Authors: Xi Li, Harlan M Krumholz, Jing Li, Frederick A Masoudi, John A Spertus, Lixin JiangAbstract:Objectives As the predominant approach to acute reperfusion for ST segment elevation myocardial infarction (STEMI) in many countries, Fibrinolytic Therapy provides a relative risk reduction for death of ∼16% across the range of baseline risk. For patients with low baseline mortality risk, Fibrinolytic Therapy may therefore provide little benefit, which may be offset by the risk of major bleeding. We aimed to construct a tool to determine if it is possible to identify a low-risk group among Fibrinolytic Therapy-eligible patients. Design Cross-sectional study. Setting The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) study includes a nationally representative retrospective sample of patients admitted with acute myocardial infarction (AMI) in 162 hospitals. Participants 3741 patients with STEMI who were Fibrinolytic-eligible but did not receive reperfusion Therapy. Main outcome measures In-hospital mortality, which was defined as a composite of death occurring within hospitalisation or withdrawal from treatment due to a terminal status at discharge. Results In the study cohort, the in-hospital mortality was 14.7%. In the derivation cohort and the validation cohort, the combination of systolic blood pressure (≥100 mm Hg), age ( Conclusions Nearly, one in five patients with STEMI who are eligible for Fibrinolytic Therapy are at a low risk for in-hospital death. Three simple factors available at the time of presentation can identify these individuals and support decision-making about the use of Fibrinolytic Therapy. Trial registration number NCT01624883.
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abstract 12197 china peace risk tool for acute myocardial infarction an early risk classification tree for decisions about Fibrinolytic Therapy
Circulation, 2014Co-Authors: Xi Li, Harlan M Krumholz, Jing Li, Frederick A Masoudi, John A Spertus, Lixin JiangAbstract:Introduction: Timely Fibrinolytic Therapy is recommended to reduce short-term mortality for patients with ST-elevation myocardial infarction (STEMI). However, the absolute treatment benefit is rela...
Robert P Giugliano - One of the best experts on this subject based on the ideXlab platform.
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effectiveness and safety of percutaneous coronary intervention after Fibrinolytic Therapy for st segment elevation acute myocardial infarction
American Journal of Cardiology, 2011Co-Authors: Suzanne J Baron, Robert P GiuglianoAbstract:The goal of treatment of an acute ST-segment elevation myocardial infarction is the timely restoration of myocardial blood flow to decrease myocardial necrosis and thereby preserve cardiac tissue and overall function. Mainstays of reperfusion treatment include Fibrinolytic Therapy and/or primary percutaneous coronary intervention. In those patients who are treated with fibrinolysis, there is debate as to whether and when they should also undergo subsequent percutaneous coronary intervention. In conclusion, the investigators review the published reports on systematic percutaneous coronary intervention after Fibrinolytic Therapy in the treatment of ST-segment elevation myocardial infarction and discuss the rationale behind this treatment strategy.
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association of culprit lesion calcium with angiographic and clinical outcomes in patients with st elevation myocardial infarction treated with Fibrinolytic Therapy
American Journal of Cardiology, 2005Co-Authors: Ajay J Kirtane, Robert P Giugliano, Ioanna Kosmidou, Dimitrios Karmpaliotis, Sabina A Murphy, Christopher P Cannon, Elliott M Antman, Eugene Braunwald, Michael C GibsonAbstract:Coronary artery calcium has been associated with a greater extent of angiographically significant coronary artery stenoses, but the angiographic and clinical outcomes associated with culprit lesion calcium (CLC) have not been fully evaluated, particularly in the stetting of ST-elevation myocardial infarction. We hypothesized that CLC would be associated with adverse angiographic and clinical outcomes in patients who had ST-elevation myocardial infarction. Data were evaluated in 3,292 patients from 6 trials of Fibrinolytic Therapy for ST-elevation myocardial infarction; 243 culprit lesions (7.4%) were calcified. CLC was associated with advanced age, history of hypertension, previous coronary artery disease, greater extent of disease, angiographically evident residual thrombus, smaller minimum luminal diameter, and larger percent residual stenosis after Fibrinolytic Therapy. CLC was associated with lower rates of arterial patency after Fibrinolytic Therapy (63.3% vs 81.3% p
Xi Li - One of the best experts on this subject based on the ideXlab platform.
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Fibrinolytic Therapy in hospitals without percutaneous coronary intervention capabilities in china from 2001 to 2011 china peace retrospective ami study
European heart journal. Acute cardiovascular care, 2017Co-Authors: Jing Li, Xi Li, Joseph S Ross, Qing Wang, Yongfei Wang, Nihar R Desai, Xiao Xu, Sudhakar V Nuti, Frederick A Masoudi, John A SpertusAbstract:Background:Fibrinolytic Therapy is the primary reperfusion strategy for ST-segment elevation myocardial infarction in China, and yet little is known about the quality of care regarding its use and whether it has changed over time. This issue is particularly important in hospitals without the capacity for cardiovascular intervention.Methods:Using a sequential cross-sectional study with two-stage random sampling in 2001, 2006, and 2011, we characterised the use, timing, type and dose of Fibrinolytic Therapy in a nationally representative sample of patients with ST-segment elevation myocardial infarction admitted to hospitals without the ability to perform percutaneous coronary intervention.Results:We identified 5306 patients; 2812 (53.0%) were admitted within 12 hours of symptom onset, of whom 2463 (87.6%) were ideal candidates for Fibrinolytic Therapy. The weighted proportion of ideal candidates receiving Fibrinolytic Therapy was 45.8% in 2001, 50.0% in 2006, and 53.0% in 2011 (Ptrend=0.0042). There were n...
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china peace risk estimation tool for in hospital death from acute myocardial infarction an early risk classification tree for decisions about Fibrinolytic Therapy
BMJ Open, 2016Co-Authors: Xi Li, Harlan M Krumholz, Jing Li, Frederick A Masoudi, John A Spertus, Lixin JiangAbstract:Objectives As the predominant approach to acute reperfusion for ST segment elevation myocardial infarction (STEMI) in many countries, Fibrinolytic Therapy provides a relative risk reduction for death of ∼16% across the range of baseline risk. For patients with low baseline mortality risk, Fibrinolytic Therapy may therefore provide little benefit, which may be offset by the risk of major bleeding. We aimed to construct a tool to determine if it is possible to identify a low-risk group among Fibrinolytic Therapy-eligible patients. Design Cross-sectional study. Setting The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) study includes a nationally representative retrospective sample of patients admitted with acute myocardial infarction (AMI) in 162 hospitals. Participants 3741 patients with STEMI who were Fibrinolytic-eligible but did not receive reperfusion Therapy. Main outcome measures In-hospital mortality, which was defined as a composite of death occurring within hospitalisation or withdrawal from treatment due to a terminal status at discharge. Results In the study cohort, the in-hospital mortality was 14.7%. In the derivation cohort and the validation cohort, the combination of systolic blood pressure (≥100 mm Hg), age ( Conclusions Nearly, one in five patients with STEMI who are eligible for Fibrinolytic Therapy are at a low risk for in-hospital death. Three simple factors available at the time of presentation can identify these individuals and support decision-making about the use of Fibrinolytic Therapy. Trial registration number NCT01624883.
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abstract 12197 china peace risk tool for acute myocardial infarction an early risk classification tree for decisions about Fibrinolytic Therapy
Circulation, 2014Co-Authors: Xi Li, Harlan M Krumholz, Jing Li, Frederick A Masoudi, John A Spertus, Lixin JiangAbstract:Introduction: Timely Fibrinolytic Therapy is recommended to reduce short-term mortality for patients with ST-elevation myocardial infarction (STEMI). However, the absolute treatment benefit is rela...
John A Spertus - One of the best experts on this subject based on the ideXlab platform.
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Fibrinolytic Therapy in hospitals without percutaneous coronary intervention capabilities in china from 2001 to 2011 china peace retrospective ami study
European heart journal. Acute cardiovascular care, 2017Co-Authors: Jing Li, Xi Li, Joseph S Ross, Qing Wang, Yongfei Wang, Nihar R Desai, Xiao Xu, Sudhakar V Nuti, Frederick A Masoudi, John A SpertusAbstract:Background:Fibrinolytic Therapy is the primary reperfusion strategy for ST-segment elevation myocardial infarction in China, and yet little is known about the quality of care regarding its use and whether it has changed over time. This issue is particularly important in hospitals without the capacity for cardiovascular intervention.Methods:Using a sequential cross-sectional study with two-stage random sampling in 2001, 2006, and 2011, we characterised the use, timing, type and dose of Fibrinolytic Therapy in a nationally representative sample of patients with ST-segment elevation myocardial infarction admitted to hospitals without the ability to perform percutaneous coronary intervention.Results:We identified 5306 patients; 2812 (53.0%) were admitted within 12 hours of symptom onset, of whom 2463 (87.6%) were ideal candidates for Fibrinolytic Therapy. The weighted proportion of ideal candidates receiving Fibrinolytic Therapy was 45.8% in 2001, 50.0% in 2006, and 53.0% in 2011 (Ptrend=0.0042). There were n...
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china peace risk estimation tool for in hospital death from acute myocardial infarction an early risk classification tree for decisions about Fibrinolytic Therapy
BMJ Open, 2016Co-Authors: Xi Li, Harlan M Krumholz, Jing Li, Frederick A Masoudi, John A Spertus, Lixin JiangAbstract:Objectives As the predominant approach to acute reperfusion for ST segment elevation myocardial infarction (STEMI) in many countries, Fibrinolytic Therapy provides a relative risk reduction for death of ∼16% across the range of baseline risk. For patients with low baseline mortality risk, Fibrinolytic Therapy may therefore provide little benefit, which may be offset by the risk of major bleeding. We aimed to construct a tool to determine if it is possible to identify a low-risk group among Fibrinolytic Therapy-eligible patients. Design Cross-sectional study. Setting The China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) study includes a nationally representative retrospective sample of patients admitted with acute myocardial infarction (AMI) in 162 hospitals. Participants 3741 patients with STEMI who were Fibrinolytic-eligible but did not receive reperfusion Therapy. Main outcome measures In-hospital mortality, which was defined as a composite of death occurring within hospitalisation or withdrawal from treatment due to a terminal status at discharge. Results In the study cohort, the in-hospital mortality was 14.7%. In the derivation cohort and the validation cohort, the combination of systolic blood pressure (≥100 mm Hg), age ( Conclusions Nearly, one in five patients with STEMI who are eligible for Fibrinolytic Therapy are at a low risk for in-hospital death. Three simple factors available at the time of presentation can identify these individuals and support decision-making about the use of Fibrinolytic Therapy. Trial registration number NCT01624883.
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abstract 12197 china peace risk tool for acute myocardial infarction an early risk classification tree for decisions about Fibrinolytic Therapy
Circulation, 2014Co-Authors: Xi Li, Harlan M Krumholz, Jing Li, Frederick A Masoudi, John A Spertus, Lixin JiangAbstract:Introduction: Timely Fibrinolytic Therapy is recommended to reduce short-term mortality for patients with ST-elevation myocardial infarction (STEMI). However, the absolute treatment benefit is rela...