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Bernard J. Gersh - One of the best experts on this subject based on the ideXlab platform.

  • Beneficial effect of Reperfusion Therapy beyond the preservation of left ventricular function in patients with acute ST-segment elevation myocardial infarction.
    International journal of cardiology, 2009
    Co-Authors: Uwe Zeymer, Bernard J. Gersh, Timm Bauer, Ralf Zahn, Anselm K. Gitt, Claus Jünger, Jochen Senges
    Abstract:

    Abstract Background Reperfusion Therapy has been shown to improve mortality in patients with acute ST-segment elevation myocardial infarction. However, in randomized clinical trials there was only a modest improvement in left ventricular ejection fraction with Reperfusion Therapy, despite a larger improvement in mortality. Methods In the prospective MITRA-Plus registry we compared 1-year mortality of inhospital survivors of ST-segment elevation myocardial infarction (STEMI) divided into nine groups with preserved (>55%), moderately reduced (41–55%) and severely reduced (≤40%) left ventricular ejection fraction (LVEF) and treated with no early Reperfusion Therapy, fibrinolysis or primary percutaneous coronary intervention (PCI) within 24h after admission. Results A total of 5867 patients were included in this analysis, 1026 (18%) without early Reperfusion, 2462 (42%) with fibrinolysis and 2379 (40%) with primary PCI. After adjustment for confounding variables in a propensity score analysis, Reperfusion Therapy (Odds ratio and 95% CI: 0.27, 0.15–0.48; 0.50, 0.32–0.79; 0.64, 0.44–0.93), fibrinolysis (Odds ratio and 95% CI: 0.27, 0.14–0.52; 0.58, 0.35–0.95; 0.60, 0.39–0.93) and primary PCI (Odds ratio and 95% CI: 0.22, 0.11–0.44; 0.34, 0.19–0.59; 0.56, 0.36–0.88) remained independent predictors of survival in comparison to no Reperfusion Therapy in the patients with preserved, moderately reduced and severely reduced LVEF, respectively. Conclusions These results suggest a beneficial effect of early Reperfusion Therapy beyond the preservation of left ventricular function, however the mechanisms need further study.

  • Delay in presentation and Reperfusion Therapy in ST-elevation myocardial infarction.
    The American journal of medicine, 2008
    Co-Authors: Henry H Ting, Bernard J. Gersh, Elizabeth H. Bradley, Yongfei Wang, Brahmajee K. Nallamothu, Véronique L. Roger, Judith H. Lichtman, Jeptha P. Curtis, Harlan M. Krumholz
    Abstract:

    Background We studied the relationship between longer delays from symptom onset to hospital presentation and the use of any Reperfusion Therapy, door-to-balloon time, and door-to-drug time.

  • regional systems of care to optimize timeliness of Reperfusion Therapy for st elevation myocardial infarction the mayo clinic stemi protocol
    Circulation, 2007
    Co-Authors: Henry H Ting, Luis H Haro, Christine M Bjerke, John F Bresnahan, Allan S. Jaffe, Ryan J Lennon, Charanjit S Rihal, David R Holmes, Bernard J. Gersh, Malcolm R Bell
    Abstract:

    Background— Quality improvement efforts have focused on strategies to improve the timeliness of Reperfusion Therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize the timeliness of Reperfusion Therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. Methods and Results— The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006. The Mayo Clinic ST-elevation myocardial infarction protocol implemented strategies to improve timeliness of Reperfusion Therapy and to coordinate systems of care for transfer between hospitals. The study sample consisted of 258 patients who presented to Saint Mar...

  • regional systems of care to optimize timeliness of Reperfusion Therapy for st elevation myocardial infarction the mayo clinic stemi protocol
    Circulation, 2007
    Co-Authors: Henry H Ting, Luis H Haro, Christine M Bjerke, John F Bresnahan, Allan S. Jaffe, Ryan J Lennon, Charanjit S Rihal, David R Holmes, Bernard J. Gersh, Malcolm R Bell
    Abstract:

    BACKGROUND: Quality improvement efforts have focused on strategies to improve the timeliness of Reperfusion Therapy in ST-elevation myocardial infarction patients who present to hospitals with and without percutaneous coronary intervention (PCI) capability. We implemented and evaluated a protocol to optimize the timeliness of Reperfusion Therapy and to coordinate systems of care for a PCI center and 28 regional hospitals located up to 150 miles away across 3 states. METHODS AND RESULTS: The present study focused on a prospective, observational cohort of 597 patients who presented with ST-segment elevation and within 12 hours of symptom onset to Saint Marys Hospital and 28 regional hospitals up to 150 miles away between May 2004 and December 2006. The Mayo Clinic ST-elevation myocardial infarction protocol implemented strategies to improve timeliness of Reperfusion Therapy and to coordinate systems of care for transfer between hospitals. The study sample consisted of 258 patients who presented to Saint Marys Hospital and were treated with primary PCI (group A), 105 patients who presented to a regional hospital with symptom onset >3 hours and then were transferred for primary PCI (group B), and 131 patients who presented to a regional hospital with symptom onset <3 hours and were treated with full-dose fibrinolytic Therapy (group C). For groups A and B, median door-to-balloon times were 71 and 116 minutes, respectively. Door-to-balloon time <90 minutes was achieved in 75% of group A and 12% of group B. Median door-to-needle time was 25 minutes for group C, and 70% had door-to-needle time <30 minutes. CONCLUSIONS: The Mayo Clinic ST-elevation myocardial infarction protocol demonstrates the feasibility of implementing strategies to optimize the timeliness of Reperfusion Therapy and the times that can be achieved through coordinated systems of care for ST-elevation myocardial infarction patients presenting to a PCI center (Saint Marys Hospital) and 28 regional hospitals without PCI capability located up to 150 miles away across 3 states.

  • Aborted myocardial infarction: a new target for Reperfusion Therapy.
    European heart journal, 2006
    Co-Authors: Freek W. A. Verheugt, Bernard J. Gersh, Paul W. Armstrong
    Abstract:

    Reperfusion Therapy for ST-elevation acute coronary syndromes aims at early and complete recanalization of the infarct-related artery in order to salvage myocardium and improve both early and late clinical outcomes. Myocardial necrosis is usually confirmed and quantified by myocardial enzyme release in plasma. However, over 10% of patients treated with Reperfusion Therapy fail to develop an enzyme rise, but do exhibit transient ECG changes, which are consistent with an aborted myocardial infarction. The earlier the Reperfusion Therapy is instituted, the higher the incidence of aborted infarction. Treatment within an hour after symptom onset may result in 25% of aborted infarction and is in combination with complete (70%) ST-segment resolution associated with better survival. This endpoint is easy to define and occurs promptly in time. The faster that effective treatment is initiated, the more likely aborted infarction will occur. Given that mortality, re-infarction, and stroke are declining in incidence, we suggest the introduction of aborted infarction as an endpoint in clinical trials of ST-elevation acute coronary syndromes.

Toshiji Iwasaka - One of the best experts on this subject based on the ideXlab platform.

Harlan M. Krumholz - One of the best experts on this subject based on the ideXlab platform.

  • ACC/AHA 2008 Statement on Performance Measurement and Reperfusion Therapy
    Journal of the American College of Cardiology, 2008
    Co-Authors: Frederick A. Masoudi, Robert O. Bonow, Ralph G. Brindis, Christopher P. Cannon, Jo Debuhr, Susan Fitzgerald, Paul A. Heidenreich, Harlan M. Krumholz, Chris Leber
    Abstract:

    This document is an official document of the American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Performance Measures. The task force formed a work group to address the challenges of performance measurement and Reperfusion Therapy. Acute Reperfusion Therapy, either with fibrinolytic Therapy or percutaneous coronary intervention (PCI), is one of the most important treatments for patients with ST-segment elevation myocardial infarction (STEMI). Randomized clinical trials have shown that Reperfusion Therapy provided to eligible patients reduces the risk of death due to all causes.1 The timeliness of Reperfusion Therapy is of central importance, because the benefits of Therapy diminish rapidly with delays in treatment. Thus, ACC/AHA guidelines recommend that fibrinolysis be provided within 30 minutes of first medical system contact and that primary PCI be provided within 90 minutes of first medical system contact for patients presenting with STEMI.1 These …

  • Delay in presentation and Reperfusion Therapy in ST-elevation myocardial infarction.
    The American journal of medicine, 2008
    Co-Authors: Henry H Ting, Bernard J. Gersh, Elizabeth H. Bradley, Yongfei Wang, Brahmajee K. Nallamothu, Véronique L. Roger, Judith H. Lichtman, Jeptha P. Curtis, Harlan M. Krumholz
    Abstract:

    Background We studied the relationship between longer delays from symptom onset to hospital presentation and the use of any Reperfusion Therapy, door-to-balloon time, and door-to-drug time.

  • Acute Reperfusion Therapy in ST-Elevation Myocardial Infarction from 1994-2003
    The American journal of medicine, 2007
    Co-Authors: Brahmajee K. Nallamothu, Hal V. Barron, John G. Canto, Martha Blaney, Susan M. Morris, Lori Parsons, Dave P. Miller, Harlan M. Krumholz
    Abstract:

    Background Appropriate utilization of acute Reperfusion Therapy is not a national performance measure for ST-elevation myocardial infarction at this time, and the extent of its contemporary use among ideal patients is unknown.

  • Racial differences in Reperfusion Therapy use in patients hospitalized with myocardial infarction: A regional phenomenon
    American heart journal, 2005
    Co-Authors: Saif S. Rathore, Paul D. Frederick, Nathan R. Every, Hal V. Barron, Harlan M. Krumholz
    Abstract:

    Background Racial differences in Reperfusion Therapy use among patients hospitalized with myocardial infarction (MI) have been previously reported as national phenomenon. However, it is unclear whether racial differences in treatment vary by region. Methods Using data from the National Registry of Myocardial Infarction-2 and -3, a cohort of patients hospitalized with MI in the United States between 1994 and 2000, we sought to determine whether racial differences in Reperfusion Therapy use varied by geographic region in patients eligible for Reperfusion Therapy with no clinical contraindications to treatment (n = 204 230). Results Black patients had lower crude rates of Reperfusion Therapy than white patients (66.5% vs 69.9%, −3.3% racial difference, 99% CI −4.4% to −2.2%) overall. However, racial differences in Reperfusion Therapy use varied by geographic region. Reperfusion Therapy rates were similar for black patients and white patients in the Northeast (67.9% black vs 65.3% white, +2.7% racial difference, 99% CI −0.5% to 5.8%) and statistically comparable for patients in the Midwest (68.3% black vs 69.0% white, −0.7% racial difference, 99% CI −2.9% to 1.5%) and West (70.7% black vs 72.6% white, −1.9% racial difference, 99% CI −5.1% to 1.2%). Racial differences in Reperfusion Therapy use were greatest for patients hospitalized in the South (64.5% black vs 71.7% white, −7.1% racial difference, 99% CI −8.7% to −5.6%). Racial differences were reduced, but geographic variations in racial differences persisted after multivariable adjustment. Conclusions Lower rates of Reperfusion Therapy use among black patients with MI do not reflect a national pattern of racial differences in treatment, but a practice pattern predominantly attributable to the South.

Tetsuro Sugiura - One of the best experts on this subject based on the ideXlab platform.

Freek W. A. Verheugt - One of the best experts on this subject based on the ideXlab platform.

  • Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction Trials, Registries, and Guidelines
    Circulation, 2009
    Co-Authors: Freek W. A. Verheugt
    Abstract:

    Reperfusion Therapy represents an important step forward in the management of patients with ST-segment elevation myocardial infarction (STEMI). Few medicinal treatments have been evaluated so well. In numerous randomized controlled trials, Reperfusion Therapy proved to reduce infarct size and improve early and long-term clinical outcome when compared with control treatment. The cornerstones of Reperfusion Therapy include both early complete recanalisation of the infarct-related artery and maintained patency over the long term. Article see p 3101 Nearly half a century ago, the first experience with Reperfusion Therapy for STEMI using fibrinolytic agents was reported, but most studies were small and had no strict electrocardiography criteria.1 In the late 1970s, the first randomized trial of intravenous streptokinase infusion in patients with acute (

  • Reperfusion Therapy Starts in the Ambulance
    Circulation, 2006
    Co-Authors: Freek W. A. Verheugt
    Abstract:

    Reperfusion Therapy for ST-elevation acute coronary syndromes aims at early and complete recanalization of the infarct-related artery in order to salvage myocardium and improve both early and late clinical outcomes. The benefit rises exponentially the earlier Therapy is initiated. The highest number of lives saved is within the first hour after symptom onset: the “golden hour.” The exponential form of the curve relating mortality to time-to-Reperfusion has major implications for the timing of treatment. The impact of delay in time-to-treatment lessens as the duration of ischemia lengthens. Consequently, reducing delays will have a much more positive return in patients presenting early for those presenting late. These considerations have provided a strong incentive for the initiation of very early Reperfusion Therapy. Article p 2398 The optimal site for initiation of Reperfusion strategies is the patient’s home or place where the infarction occurs. Prehospital diagnosis and treatment has been performed since 1985, when Gotsman1 applied prehospital fibrinolytic Therapy with streptokinase in Jerusalem, Israel. This strategy has proven to be feasible, relatively safe, and efficacious. The time gain with prehospital fibrinolysis is &1 hour and results in 15% relative risk reduction of early mortality.1a Later, this form of Therapy spread over the world, including the United States, where in the Seattle and Boston areas a time gain of at least 30 minutes could be reached.2,3 The major component of time gain in prehospital triage is bypassing emergency departments of hospitals, where door-to-needle easily exceeds 30 minutes, the upper limit mandated in the guidelines. An absolute prerequisite for prehospital …

  • Aborted myocardial infarction: a new target for Reperfusion Therapy.
    European heart journal, 2006
    Co-Authors: Freek W. A. Verheugt, Bernard J. Gersh, Paul W. Armstrong
    Abstract:

    Reperfusion Therapy for ST-elevation acute coronary syndromes aims at early and complete recanalization of the infarct-related artery in order to salvage myocardium and improve both early and late clinical outcomes. Myocardial necrosis is usually confirmed and quantified by myocardial enzyme release in plasma. However, over 10% of patients treated with Reperfusion Therapy fail to develop an enzyme rise, but do exhibit transient ECG changes, which are consistent with an aborted myocardial infarction. The earlier the Reperfusion Therapy is instituted, the higher the incidence of aborted infarction. Treatment within an hour after symptom onset may result in 25% of aborted infarction and is in combination with complete (70%) ST-segment resolution associated with better survival. This endpoint is easy to define and occurs promptly in time. The faster that effective treatment is initiated, the more likely aborted infarction will occur. Given that mortality, re-infarction, and stroke are declining in incidence, we suggest the introduction of aborted infarction as an endpoint in clinical trials of ST-elevation acute coronary syndromes.

  • Coronary Reperfusion Therapy in Clinical Practice - Coronary Reperfusion Therapy in Clinical Practice
    2006
    Co-Authors: Freek W. A. Verheugt
    Abstract:

    1. Pharmacology of Fibrinolytic Agents 2. Pre-Hospital Triage and Treatment for Suspected Acute Myocardial Infarction 3. General Principles of Reperfusion Therapy in Acute Myocardial Infarction 4. Primary Coronary Interventions for Acute Myocardial Infarction 5. Antiplatelet Therapy in Reperfusion 6. Anticoagulants as Adjunctive Therapy to Reperfusion Therapy 7. Pharmacological Interventions for Reperfusion Therapy for Acute Myocardial Infarction 8. Evaluation of Reperfusion Therapy 9. Rescue Coronary Interventions in Acute Myocardial Infarction