Optimizing the pharmacoinvasive approach to acute ST-segment elevation myocardial infarction: use of half-dose thrombolytic therapy in combination with glycoprotein IIb/IIIa receptor inhibitors compared with full-dose thrombolytic therapy in the setting of routine urgent post-thrombolytic percutaneous coronary intervention




Background


Many studies have shown that a pharmacoinvasive strategy of urgent percutaneous coronary intervention following thrombolytic therapy in ST-segment elevation myocardial infarction (STEMI) patients is associated with better outcomes than thrombolytics alone. Some studies used full-dose thrombolytics and some used half-dose thrombolytics with glycoprotein IIb/IIIa inhibitors. The comparative efficacy and safety of these regimens remain unclear.




Methods


We prospectively enrolled 1632 patients from 2001 to 2009 into a single-center STEMI registry. We limited the cohort to STEMI patients who had thrombolytics at an outside hospital and were transferred for urgent cardiac catheterization at our center ( N =715). Patients received either full-dose thrombolytics or half-dose thrombolytics plus glycoprotein IIb/IIIa inhibitors. Patients were propensity matched into blocks by Thrombolysis in Myocardial Infarction (TIMI) risk score. Logistic regression (OR) and Cox’s proportional hazard modeling (HR) on propensity-matched patients were conducted for clinical end points with 95% confidence intervals.

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Nov 16, 2017 | Posted by in CARDIOLOGY | Comments Off on Optimizing the pharmacoinvasive approach to acute ST-segment elevation myocardial infarction: use of half-dose thrombolytic therapy in combination with glycoprotein IIb/IIIa receptor inhibitors compared with full-dose thrombolytic therapy in the setting of routine urgent post-thrombolytic percutaneous coronary intervention

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