HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kastrati, A. Search for Related Content PubMed PubMed Citation Articles by Kastrati, A.

CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

A randomized trial comparing myocardial salvage achieved by coronary stenting versus balloon angioplasty in patients with acute myocardial infarction considered ineligible for reperfusion therapy

Adnan Kastrati, MD^*,*, Julinda Mehilli, MD^*, Stefan Nekolla, PhD, Hildegard Bollwein, MD, Stefan Martinoff, MD^*, Jürgen Pache, MD, Helmut Schühlen, MD^*, Melchior Seyfarth, MD, Meinrad Gawaz, MD^*, Franz-Josef Neumann, MD, Josef Dirschinger, MD, Markus Schwaiger, MD, Albert Schömig, MD^* STOPAMI-3 Study Investigators

^* Deutsches Herzzentrum, Munich, Germany
1. Medizinische Klinik rechts der Isar, Munich, Germany
Klinik und Poliklinik für Nuklearmedizin rechts der Isar, Technische Universität, Munich, Germany

Manuscript received May 14, 2003; revised manuscript received July 24, 2003, accepted July 29, 2003.

^* Reprint requests and correspondence: Dr. Adnan Kastrati, Deutsches Herzzentrum Lazarettstr. 36, 80636 München, Germany
kastrati{at}dhm.mhn.de

OBJECTIVES: We assessed myocardial salvage achieved by reperfusion with percutaneous coronary interventions (PCI) and compared stenting with balloon angioplasty (PTCA) in patients with acute myocardial infarction (AMI) ineligible for thrombolysis.

BACKGROUND: A substantial proportion of patients with AMI are currently considered ineligible for thrombolysis, and reperfusion treatment is frequently not recommended for them. It is not known whether these patients benefit from PCI.

METHODS: The Stent or PTCA for Occluded Coronary Arteries in Patients with Acute Myocardial Infarction Ineligible for Thrombolysis (STOPAMI-3) trial, a randomized, open-label study, included 611 patients with AMI who were ineligible for thrombolysis (lack of ST-segment elevation on the electrocardiogram, late presentation >12 h after symptom onset, and contraindications to thrombolysis). Patients were randomly assigned to receive either coronary artery stenting (n = 305) or PTCA (n = 306). Scintigraphic myocardial salvage index (proportion of the initial myocardial perfusion defect that was salvaged by reperfusion) was the primary end point of the study.

RESULTS: A considerable myocardial salvage was achieved with both stenting and PTCA. In patients assigned to receive stenting, the median size of the salvage index was 0.54 (25th and 75th percentiles, 0.29 and 0.87), as compared with a median of 0.50 (25th and 75th percentiles, 0.26 and 0.82) in the group assigned to receive PTCA (p = 0.20). Mortality at six months was 8.2% in the group of patients assigned to receive stenting and 9.2% in the group of patients assigned to receive PTCA (p = 0.69).

CONCLUSIONS: Patients with AMI who are currently considered ineligible for thrombolysis by conventional guidelines may greatly benefit from primary PCI. The benefit seems to be comparable when a strategy of stenting is compared with a strategy of PTCA in these patients.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CK = creatine kinase   ECG = electrocardiogram   LV = left ventricle/ventricular   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   STOPAMI-3 = Stent or PTCA for Occluded Coronary Arteries in Patients with Acute Myocardial Infarction Ineligible for Thrombolysis study

This article has been cited by other articles:

				G. Ndrepepa, J. Mehilli, S. Martinoff, M. Schwaiger, A. Schomig, and A. Kastrati Evolution of Left Ventricular Ejection Fraction and its Relationship to Infarct Size After Acute Myocardial Infarction J. Am. Coll. Cardiol., July 10, 2007; 50(2): 149 - 156. [Abstract] [Full Text] [PDF]

				T. Svilaas, I. C C van der Horst, and F. Zijlstra A quantitative estimate of bare-metal stenting compared with balloon angioplasty in patients with acute myocardial infarction: angiographic measures in relation to clinical outcome Heart, July 1, 2007; 93(7): 792 - 800. [Abstract] [Full Text] [PDF]

				P. Massoudy, M. Thielmann, A. Szabo, I. Aleksic, E. Kottenberg-Assenmacher, J. Szolnoki, and H. Jakob Aortocoronary Shunting During Off-Pump Coronary Artery Bypass Surgery as Acute Reperfusion Strategy in ST-Elevation Myocardial Infarction. Ann. Thorac. Surg., October 1, 2006; 82(4): 1521 - 1523. [Abstract] [Full Text] [PDF]

				A. Schomig, G. Ndrepepa, and A. Kastrati Late myocardial salvage: time to recognize its reality in the reperfusion therapy of acute myocardial infarction Eur. Heart J., August 2, 2006; 27(16): 1900 - 1907. [Abstract] [Full Text] [PDF]

				F. W.A. Verheugt, B. J. Gersh, and P. W. Armstrong Aborted myocardial infarction: a new target for reperfusion therapy Eur. Heart J., April 2, 2006; 27(8): 901 - 904. [Abstract] [Full Text] [PDF]

				M. Gick, N. Jander, H.-P. Bestehorn, R.-P. Kienzle, M. Ferenc, K. Werner, T. Comberg, K. Peitz, D. Zohlnhofer, V. Bassignana, et al. Randomized Evaluation of the Effects of Filter-Based Distal Protection on Myocardial Perfusion and Infarct Size After Primary Percutaneous Catheter Intervention in Myocardial Infarction With and Without ST-Segment Elevation Circulation, September 6, 2005; 112(10): 1462 - 1469. [Abstract] [Full Text] [PDF]

				G. De Luca, H. Suryapranata, R. Grimaldi, and M. Chiariello Coronary stenting and abciximab in primary angioplasty for ST-segment-elevation myocardial infarction QJM, September 1, 2005; 98(9): 633 - 641. [Abstract] [Full Text] [PDF]

				A. Schomig, J. Mehilli, D. Antoniucci, G. Ndrepepa, C. Markwardt, F. Di Pede, S. G. Nekolla, K. Schlotterbeck, H. Schuhlen, J. Pache, et al. Mechanical Reperfusion in Patients With Acute Myocardial Infarction Presenting More Than 12 Hours From Symptom Onset: A Randomized Controlled Trial JAMA, June 15, 2005; 293(23): 2865 - 2872. [Abstract] [Full Text] [PDF]

				H Suryapranata, G De Luca, A W J van 't Hof, J P Ottervanger, J C A Hoorntje, J-H E Dambrink, A T M Gosselink, F Zijlstra, and M-J de Boer Is routine stenting for acute myocardial infarction superior to balloon angioplasty? A randomised comparison in a large cohort of unselected patients Heart, May 1, 2005; 91(5): 641 - 645. [Abstract] [Full Text] [PDF]

				W. W. O'Neill, S. R. Dixon, and C. L. Grines The year in interventional cardiology J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1117 - 1134. [Full Text] [PDF]

				J. Mehilli, G. Ndrepepa, A. Kastrati, S. G. Nekolla, C. Markwardt, H. Bollwein, J. Pache, S. Martinoff, J. Dirschinger, M. Schwaiger, et al. Gender and myocardial salvage after reperfusion treatment in acute myocardial infarction J. Am. Coll. Cardiol., March 15, 2005; 45(6): 828 - 831. [Abstract] [Full Text] [PDF]

				Other articles noted Evid. Based Med., September 1, 2004; 9(5): e5 - e5. [Full Text] [PDF]

				G. Ndrepepa, J. Mehilli, M. Schwaiger, H. Schuhlen, S. Nekolla, S. Martinoff, C. Schmitt, J. Dirschinger, A. Schomig, and A. Kastrati Prognostic Value of Myocardial Salvage Achieved by Reperfusion Therapy in Patients with Acute Myocardial Infarction J. Nucl. Med., May 1, 2004; 45(5): 725 - 729. [Abstract] [Full Text] [PDF]