Advertisement

Click here for more guidelines.
2012 ACCF/ AATS/ SCAI/ STS Expert Consensus Document on Transcatheter Aortic Valve Replacement
ACCF/ SCAI/ STS/ AATS/ AHA/ ASNC/ HFSA/ SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update
2012 ACCF/ AHA/ ACR/ SCAI/ SIR/ STS/ SVM/ SVN Key Data Elements and Definitions for Peripheral Atherosclerotic Vascular Disease

 
About JACC CME
Policy on Privacy and Confidentiality
Disclosures
Important Information
 

JACC Imaging Homepage JACC Interventions Homepage
Still not a subscriber to JACC Imaging or JACC Interventions?
Click here
to sign up now!

Submit Manuscripts
Author Information
Subscribe/Renew
Order Reprints
Email Alerts
Feedback
RSS Feed
CME
 
 

Cardiosmart
Cardiosource
CVN
Imaging Library
JACC Imaging
JACC Interventions
 
 

About the Journal
Editorial Board & Staff
 
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2005; 46:417-424, doi:10.1016/j.jacc.2005.04.042 (Published online 5 July 2005).
© 2005 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow View Online Only Appendix
Right arrow All Versions of this Article:
j.jacc.2005.04.042v1
46/3/417    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Le May, M. R.
Right arrow Articles by Higginson, L. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Le May, M. R.
Right arrow Articles by Higginson, L. A.

CLINICAL RESEARCH: CLINICAL TRIALS

Combined Angioplasty and Pharmacological Intervention Versus Thrombolysis Alone in Acute Myocardial Infarction (CAPITAL AMI Study)

Michel R. Le May, MD, FACC*, George A. Wells, PhD, Marino Labinaz, MD, FACC, Richard F. Davies, MD, FACC, Michele Turek, MD, Danielle Leddy, MD, Justin Maloney, MD, Tim McKibbin, MD, Brendan Quinn, MD, Rob S. Beanlands, MD, Chris Glover, MD, Jean-François Marquis, MD, Edward R. O'Brien, MD, FACC, William L. Williams, MD, FACC and Lyall A. Higginson, MD, FACC

Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada

Manuscript received December 8, 2004; revised manuscript received April 3, 2005, accepted April 13, 2005.

* Reprint requests and correspondence: Dr. Michel R. Le May, Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada K1Y 4W7 (Email: mlemay{at}ottawaheart.ca).

OBJECTIVES: We compared a strategy of tenecteplase (TNK)-facilitated angioplasty with one of TNK alone in patients presenting with high-risk ST-segment elevation myocardial infarction (STEMI).

BACKGROUND: Previous trials show that thrombolysis followed by immediate angioplasty for the treatment of STEMI does not improve ischemic outcomes compared with thrombolysis alone and is associated with excessive bleeding complications. Since the publication of these trials, however, significant pharmacological and technological advances have occurred.

METHODS: We randomized 170 patients with high-risk STEMI to treatment with TNK alone (84 patients) or TNK-facilitated angioplasty (86 patients). The primary end point was a composite of death, reinfarction, recurrent unstable ischemia, or stroke at six months.

RESULTS: At six months, the incidence of the primary end point was 24.4% in the TNK-alone group versus 11.6% in the TNK-facilitated angioplasty group (p = 0.04). This difference was driven by a reduction in the rate of recurrent unstable ischemia (20.7% vs. 8.1%, p = 0.03). There was a trend toward a lower reinfarction rate with TNK-facilitated angioplasty (14.6% vs. 5.8%, p = 0.07). No significant differences were observed in the rates of death or stroke. Major bleeding was observed in 7.1% of the TNK-alone group and in 8.1% of the TNK-facilitated angioplasty group (p = 1.00).

CONCLUSIONS: In patients presenting with high-risk STEMI, TNK plus immediate angioplasty reduced the risk of recurrent ischemic events compared with TNK alone and was not associated with an increase in major bleeding complications.

Abbreviations and Acronyms
  ACT = activated clotting time
  ASSENT = Assessment of the Safety and Efficacy of a New Thrombolytic Agent
  CABG = coronary artery bypass graft surgery
  IRA = infarct-related artery
  PCI = percutaneous coronary intervention
  STEMI = ST-segment elevation myocardial infarction
  TIMI = Thrombolysis In Myocardial Infarction
  TNK = tenecteplase




This article has been cited by other articles:


Home page
 Eur Heart JHome page
A. T. Yan, R. T. Yan, W. J. Cantor, B. Borgundvaag, E. A. Cohen, D. H. Fitchett, V. Dzavik, J. Ducas, M. Tan, A. Casanova, et al.
Relationship between risk stratification at admission and treatment effects of early invasive management following fibrinolysis: insights from the Trial of Routine ANgioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI)
Eur. Heart J., August 2, 2011; 32(16): 1994 - 2002.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
C. B. Granger
Who should have a routine early invasive approach after fibrinolytic therapy?
Eur. Heart J., August 2, 2011; 32(16): 1961 - 1963.
[Full Text] [PDF]

Home page
 Circ Cardiovasc IntervHome page
Y. P. Clever, B. Cremers, A. Link, M. Bohm, and B. Scheller
Long-Term Follow-Up of Early Versus Delayed Invasive Approach After Fibrinolysis in Acute Myocardial Infarction
Circ Cardiovasc Interv, August 1, 2011; 4(4): 342 - 348.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
S. P. D'Souza, M. A. Mamas, D. G. Fraser, and F. Fath-Ordoubadi
Routine early coronary angioplasty versus ischaemia-guided angioplasty after thrombolysis in acute ST-elevation myocardial infarction: a meta-analysis
Eur. Heart J., April 2, 2011; 32(8): 972 - 982.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
P. L. Sanchez and F. Fernandez-Aviles
Routine early coronary angioplasty after thrombolysis in acute ST-elevation myocardial infarction: lysis is not the final step
Eur. Heart J., April 2, 2011; 32(8): 927 - 930.
[Full Text] [PDF]

Home page
 The ESC Textbook of Acute and Intensive Cardiac CareHome page
K. Huber, K. A. A. Fox, P. Goldstein, and N. Danchin
Chapter 40 Systems of care for patients with acute coronary syndrome
The ESC Textbook of Acute and Intensive Cardiac Care, December 1, 2010; 1(1): med-9780199584314-chapter - med-9780199584314-chapter.
[Abstract] [Full Text] [PDF]

Home page
 The ESC Textbook of Acute and Intensive Cardiac CareHome page
N. Danchin, N. Aissaoui, and E. Durand
Chapter 41 ST-segment elevation myocardial infarction
The ESC Textbook of Acute and Intensive Cardiac Care, December 1, 2010; 1(1): med-9780199584314-chapter - med-9780199584314-chapter.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
S. Desch, I. Eitel, K. Rahimi, S. de Waha, G. Schuler, and H. Thiele
Timing of invasive treatment after fibrinolysis in ST elevation myocardial infarction - a meta-analysis of immediate or early routine versus deferred or ischemia-guided randomised controlled trials
Heart, November 1, 2010; 96(21): 1695 - 1702.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
R. E. O'Connor, L. Bossaert, H.-R. Arntz, S. C. Brooks, D. Diercks, G. Feitosa-Filho, J. P. Nolan, T. L. V. Hoek, D. L. Walters, A. Wong, et al.
Part 9: Acute Coronary Syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations
Circulation, October 19, 2010; 122(16_suppl_2): S422 - S465.
[Full Text] [PDF]

Home page
 Cleveland Clinic Journal of MedicineHome page
E. B. HANNA, T. A. HENNEBRY, and M. S. ABU-FADEL
Combined reperfusion strategies in ST-segment elevation MI: Rationale and current role
Cleveland Clinic Journal of Medicine, September 1, 2010; 77(9): 629 - 638.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
F. Borgia, S. G. Goodman, S. Halvorsen, W. J. Cantor, F. Piscione, M. R. Le May, F. Fernandez-Aviles, P. L. Sanchez, K. Dimopoulos, B. Scheller, et al.
Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation myocardial infarction: a meta-analysis
Eur. Heart J., September 1, 2010; 31(17): 2156 - 2169.
[Abstract] [Full Text] [PDF]

Home page
 Circ Cardiovasc IntervHome page
P. L. Sanchez, F. Gimeno, P. Ancillo, J. J. Sanz, J. H. Alonso-Briales, F. Bosa, I. Santos, J. Sanchis, A. Bethencourt, J. Lopez-Messa, et al.
Role of the Paclitaxel-Eluting Stent and Tirofiban in Patients With ST-Elevation Myocardial Infarction Undergoing Postfibrinolysis Angioplasty: The GRACIA-3 Randomized Clinical Trial
Circ Cardiovasc Interv, August 1, 2010; 3(4): 297 - 307.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
E. Bohmer, P. Hoffmann, M. Abdelnoor, H. Arnesen, and S. Halvorsen
Efficacy and Safety of Immediate Angioplasty Versus Ischemia-Guided Management After Thrombolysis in Acute Myocardial Infarction in Areas With Very Long Transfer Distances: Results of the NORDISTEMI (NORwegian study on DIstrict treatment of ST-Elevation Myocardial Infarction)
J. Am. Coll. Cardiol., January 12, 2010; 55(2): 102 - 110.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
J N Townend and H C Routledge
The impact of prehospital thrombolytic treatment on re-infarction rates
Heart, January 1, 2010; 96(1): 72 - 72.
[Full Text] [PDF]

Home page
 Oxford Textbook of Interventional CardiologyHome page
Z. Adam and M. A. de Belder
Chapter 16 Primary percutaneous coronary intervention for ST elevation myocardial infarction
Oxford Textbook of Interventional Cardiology, January 1, 2010; 1(1): med-9780199569083-chapter - med-9780199569083-chapter.
[Abstract] [Full Text]

Home page
 CMAJHome page
M. Le May
Code STEMI: implementation of a city-wide program for rapid assessment and management of myocardial infarction
Can. Med. Assoc. J., October 13, 2009; 181(8): E136 - E137.
[Full Text] [PDF]

Home page
 J Am Coll Cardiol IntvHome page
N. Danchin
Systems of Care for ST-Segment Elevation Myocardial Infarction: Impact of Different Models on Clinical Outcomes
J. Am. Coll. Cardiol. Intv., October 1, 2009; 2(10): 901 - 908.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
F. Van de Werf
Year 2008 ESC ST-segment elevation myocardial infarction guidelines: implications for the interventional cardiologist--from evidence to recommendations and practice
Eur. Heart J. Suppl., June 1, 2009; 11(suppl_C): C31 - C37.
[Full Text] [PDF]

Home page
 HeartHome page
V Bongard, J Puel, D Savary, L Belle, S Charpentier, Y Cottin, L Soulat, M Elbaz, D Miljkovic, P. G Steg, et al.
Predictors of infarct artery patency after prehospital thrombolysis: the multicentre, prospective, observational OPTIMAL study
Heart, May 1, 2009; 95(10): 799 - 806.
[Abstract] [Full Text] [PDF]

Home page
 ESC Textbook of Cardiovascular MedicineHome page
C. W. Hamm, H. Mollmann, J.-P. Bassand, and F. van de Werf
CHAPTER 16 Acute Coronary Syndromes
ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
Authors/Task Force Members, F. Van de Werf, J. Bax, A. Betriu, C. Blomstrom-Lundqvist, F. Crea, V. Falk, G. Filippatos, K. Fox, K. Huber, et al.
Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology:
Eur. Heart J., December 1, 2008; 29(23): 2909 - 2945.
[Full Text] [PDF]

Home page
 Eur Heart J SupplHome page
D. Dudek, T. Rakowski, A. Dziewierz, and P. Kleczynski
PCI after lytic therapy: when and how?
Eur. Heart J. Suppl., December 1, 2008; 10(suppl_J): J15 - J20.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
G. W. Stone
Angioplasty Strategies in ST-Segment-Elevation Myocardial Infarction: Part II: Intervention After Fibrinolytic Therapy, Integrated Treatment Recommendations, and Future Directions
Circulation, July 29, 2008; 118(5): 552 - 566.
[Full Text] [PDF]

Home page
 CirculationHome page
H. D. White
Systems of Care: Need for Hub-and-Spoke Systems for Both Primary and Systematic Percutaneous Coronary Intervention After Fibrinolysis
Circulation, July 15, 2008; 118(3): 219 - 222.
[Full Text] [PDF]

Home page
 ChestHome page
S. G. Goodman, V. Menon, C. P. Cannon, G. Steg, E. M. Ohman, and R. A. Harrington
Acute ST-Segment Elevation Myocardial Infarction: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Chest, June 1, 2008; 133(6_suppl): 708S - 775S.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. Sabate
Revascularization of the Infarct-Related Artery: Never Too Late to Do Well
J. Am. Coll. Cardiol., March 4, 2008; 51(9): 965 - 967.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
R. W. Smalling, G. M. Giesler, V. R. Julapalli, A. E. Denktas, S. M. Sdringola, M. T. Vooletich, J. J. McCarthy, R. N. Bradley, D. E. Persse, B. K. Richter, et al.
Pre-Hospital Reduced-Dose Fibrinolysis Coupled With Urgent Percutaneous Coronary Intervention Reduces Time to Reperfusion and Improves Angiographic Perfusion Score Compared With Prehospital Fibrinolysis Alone or Primary Percutaneous Coronary Intervention: Results of the PATCAR Pilot Trial
J. Am. Coll. Cardiol., October 16, 2007; 50(16): 1612 - 1614.
[Full Text] [PDF]

Home page
 CirculationHome page
M. Sanz, R. W. Smalling, D. L. Brewer, W. J. French, L. A. Smaha, H. H. Ting, and D. E. Casey
Development of Systems of Care for ST-Elevation Myocardial Infarction Patients: The Physician Perspective
Circulation, July 10, 2007; 116(2): e39 - e42.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
T. J. Kiernan, H. H. Ting, and B. J. Gersh
Facilitated percutaneous coronary intervention: current concepts, promises, and pitfalls
Eur. Heart J., July 1, 2007; 28(13): 1545 - 1553.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
J. Labarere, L. Belle, M. Fourny, N. Genes, J.-M. Lablanche, D. Blanchard, J.-P. Cambou, N. Danchin, and for the Unite de Soins Intensifs Coronaires 2000 I
Outcomes of Myocardial Infarction in Hospitals With Percutaneous Coronary Intervention Facilities
Arch Intern Med, May 14, 2007; 167(9): 913 - 920.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
J. Legutko, Z. Siudak, D. Dudek, and L. Rzeszutko
Percutaneous Coronary Intervention vs Thrombolysis for ST-Elevation Myocardial Infarction
JAMA, March 28, 2007; 297(12): 1314 - 1314.
[Full Text] [PDF]

Home page
 Emerg. Med. J.Home page
J Kendall
The optimum reperfusion pathway for ST elevation acute myocardial infarction: development of a decision framework
Emerg. Med. J., January 1, 2007; 24(1): 52 - 56.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
M Sejersten, Y Birnbaum, R S Ripa, C Maynard, G S Wagner, P Clemmensen, and for the DANAMI-2 Investigators
Influences of electrocardiographic ischaemia grades and symptom duration on outcomes in patients with acute myocardial infarction treated with thrombolysis versus primary percutaneous coronary intervention: results from the DANAMI-2 trial
Heart, November 1, 2006; 92(11): 1577 - 1582.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
J.-P. Collet, G. Montalescot, M. Le May, M. Borentain, and A. Gershlick
Percutaneous Coronary Intervention After Fibrinolysis: A Multiple Meta-Analyses Approach According to the Type of Strategy
J. Am. Coll. Cardiol., October 3, 2006; 48(7): 1326 - 1335.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
W. B. Borden and D. P. Faxon
Facilitated Percutaneous Coronary Intervention
J. Am. Coll. Cardiol., September 19, 2006; 48(6): 1120 - 1128.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
P. Kaul, W.-C. Chang, A. M. Lincoff, P. Aylward, A. Betriu, C. Bode, R. M. Califf, E. M. Ohman, V. Guetta, P. G. Steg, et al.
Optimizing use of revascularization and clinical outcomes in ST-elevation myocardial infarction: insights from the GUSTO-V trial
Eur. Heart J., May 2, 2006; 27(10): 1198 - 1206.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
S. R. Dixon, C. L. Grines, and W. W. O'Neill
The Year in Interventional Cardiology
J. Am. Coll. Cardiol., April 18, 2006; 47(8): 1689 - 1706.
[Full Text] [PDF]

Home page
 Eur Heart JHome page
E. Boersma and The Primary Coronary Angioplasty vs. Thrombolysis
Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients
Eur. Heart J., April 1, 2006; 27(7): 779 - 788.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
S. C. Smith Jr, T. E. Feldman, J. W. Hirshfeld Jr, A. K. Jacobs, M. J. Kern, S. B. King III, D. A. Morrison, W. W. O'Neill, H. V. Schaff, P. L. Whitlow, et al.
ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention)
J. Am. Coll. Cardiol., January 3, 2006; 47(1): 216 - 235.
[Full Text] [PDF]

Home page
 CirculationHome page
S. C. Smith Jr, T. E. Feldman, J. W. Hirshfeld Jr, A. K. Jacobs, M. J. Kern, S. B. King III, D. A. Morrison, W. W. O'Neill, H. V. Schaff, P. L. Whitlow, et al.
ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention)
Circulation, January 3, 2006; 113(1): 156 - 175.
[Full Text] [PDF]

Home page
 CMAJHome page
W. J. Cantor, F. Brunet, C. P. Ziegler, A. Kiss, and L. J. Morrison
Immediate angioplasty after thrombolysis: a systematic review
Can. Med. Assoc. J., December 6, 2005; 173(12): 1473 - 1481.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
H.-J. Dieker, M. A. Brouwer, and F. W.A. Verheugt
ESC guidelines for percutaneous coronary interventions
Eur. Heart J., November 2, 2005; 26(22): 2475 - 2475.
[Full Text] [PDF]

Home page
 JWatch Emergency Med.Home page
Is There an Advantage of Immediate PCI After Fibrinolysis for STEMI?
Journal Watch Emergency Medicine, October 12, 2005; 2005(1012): 1 - 1.
[Full Text]

Home page
 Journal Watch CardiologyHome page
Fibrinolysis-Facilitated PCI for STEMI?
Journal Watch Cardiology, September 23, 2005; 2005(923): 3 - 3.
[Full Text]


 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement