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【medical-news】《Lancet》CARESS-in-AMI研究：ST段抬高
Summary
Background
Thrombolysis remains the treatment of choice in ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be done within 90 min. However, the best subsequent management of patients after thrombolytic therapy remains unclear. To assess the best management, we randomised patients with STEMI treated by thrombolysis and abciximab at a non-interventional hospital to immediate transfer for PCI, or to standard medical therapy with transfer for rescue angioplasty.
Methods
600 patients aged 75 years or younger with one or more high-risk features (extensive ST-segment elevation, new-onset left bundle branch block, previous myocardial infarction, Killip class >2, or left ventricular ejection fraction ≤35%) in hospitals in France, Italy, and Poland were treated with half-dose reteplase, abciximab, heparin, and aspirin, and randomly assigned to immediate transfer to the nearest interventional centre for PCI, or to management in the local hospital with transfer only in case of persistent ST-segment elevation or clinical deterioration. The primary outcome was a composite of death, reinfarction, or refractory ischaemia at 30 days, and analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number 00220571.
Findings
Of the 299 patients assigned to immediate PCI, 289 (97·0%) underwent angiography, and 255 (85·6%) received PCI. Rescue PCI was done in 91 patients (30·3%) in the standard care/rescue PCI group. The primary outcome occurred in 13 patients (4·4%) in the immediate PCI group compared with 32 (10·7%) in the standard care/rescue PCI group (hazard ratio 0·40; 95% CI 0·21–0·76, log rank p=0·004). Major bleeding was seen in ten patients in the immediate group and seven in the standard care/rescue group (3·4% vs 2·3%, p=0·47). Strokes occurred in two patients in the immediate group and four in the standard care/rescue group (0·7% vs 1·3%, p=0·50).
Interpretation
Immediate transfer for PCI improves outcome in high-risk patients with STEMI treated at a non-interventional centre with half-dose reteplase and abciximab.
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Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined Abciximab REteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI): an open, prospective, randomised, multicentre trial
即刻冠脉血管成形术 VS 标准治疗后冠脉补救性血管成形术------阿昔单抗联合瑞替普酶支架在AMI病人中的疗效研究:一个开放的,前瞻性的,随机的多中心试验
Summary
概要
Background
背景
Thrombolysis remains the treatment of choice in ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be done within 90 min. However, the best subsequent management of patients after thrombolytic therapy remains unclear. To assess the best management, we randomised patients with STEMI treated by thrombolysis and abciximab at a non-interventional hospital to immediate transfer for PCI, or to standard medical therapy with transfer for rescue angioplasty.
在治疗ST段抬高的心肌梗死（STEMI）中,若90分钟内不能行PCI术,溶栓仍是治疗的手段。然而，给予溶栓治疗后采取何种处理对预后最好仍不明了。为了评估最好的处理，我们将在非介入治疗医院的STEMI患者随机分成溶栓+阿昔单抗组和立即转院行PCI术或者经过标准AMI治疗后再转院行补救血管成形术。
Methods
方法
600 patients aged 75 years or younger with one or more high-risk features (extensive ST-segment elevation, new-onset left bundle branch block, previous myocardial infarction, Killip class >2, or left ventricular ejection fraction ≤35%) in hospitals in France, Italy, and Poland were treated with half-dose reteplase, abciximab, heparin, and aspirin, and randomly assigned to immediate transfer to the nearest interventional centre for PCI, or to management in the local hospital with transfer only in case of persistent ST-segment elevation or clinical deterioration. The primary outcome was a composite of death, reinfarction, or refractory ischaemia at 30 days, and analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number 00220571.
在法国、意大利和波兰三个国家的医院的600名75岁及以下的AMI病人均予半剂量的瑞替普酶，阿昔单抗，肝素及阿司匹林治疗后，随机分成立即转送至最近的介入中心行PCI或者留在本院治疗，除非出现持续性ST段抬高或病情恶化，否则均不转院。这600名患者均有一个以上的AMI高危因素（广泛的ST段抬高，新发的左束支传导阻滞，原有心梗病史，Killip分级>2级，或者左室EF≤35%）。
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作者:admin@医学,生命科学 2011-05-24 17:17
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