• 作者：Vicente Bodí ; ^a ; ^{vicentbodi@hotmail.com} ; Eva Rumiz^a ; Pilar Merlos^a ; Julio Nunez^a ; Maria P. Ló ; pez-Lereu^c ; José ; V. Monmeneu^c ; Fabiá ; n Chaustre^a ; David Moratal^d ; Isabel Trapero^a ; Maria L. Blasco^b ; Ricardo Oltra^b ; Rafael Sanjuá ; n^b ; Francisco J. Chorro^a ; À ; ngel Llà ; cer^a ; Juan Sanchis^a
• 关键词：AP ; angioplastia primaria ; EAC ; evento adverso cardiaco ; FI ; estrategia farmacoinvasiva ; IAMCEST ; infarto agudo de miocardio con elevació ; n del segmento ST ; RMC ; resonancia magn&eacute ; tica cardiaca ; TIMI ; Thrombolysis in Myocardial Infarction
• 刊名：Revista Espa帽ola de Cardiolog铆a
• 出版年：2011
• 期刊代码：pca308_03008932
• 类别：med
• 出版时间：February 2011
• 卷：64
• 期：2
• 页码：111-120
• 文件大小：484 K

Introduction and objectives

Pharmacoinvasive strategy represents an attractive alternative to primary angioplasty. Using cardiovascular magnetic resonance imaging we compared the left ventricular outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction.

Methods

Cardiovascular magnetic resonance was performed 1 week and 6 months after infarction in two consecutive cohorts of patients included in a prospective university hospital ST-segment elevation myocardial infarction registry. During the period 2004-2006, 151 patients were treated with pharmacoinvasive strategy (thrombolysis followed by routine non-immediate angioplasty). During the period 2007-2008, 93 patients were treated with primary angioplasty. A propensity score matched population was also evaluated.

Results

At 1-week cardiovascular magnetic resonance, pharmacoinvasive strategy and primary angioplasty patients showed a similar extent of area at risk (29 卤 15 vs. 29 卤 17%, P = .9). Non-significant differences were detected by cardiovascular magnetic resonance at 1 week and at 6 months in infarct size, salvaged myocardium, microvascular obstruction, ejection fraction, end-diastolic volume index and end-systolic volume index (P > .2 in all cases). The same trend was observed in 1-to-1 propensity score matched patients. The rate of major adverse cardiac events (death and/or re-infarction) at 1 year was 6%in pharmacoinvasive strategy and 7%in primary angioplasty patients (P = .7).

Conclusions

A pharmacoinvasive strategy including thrombolysis and routine non-immediate angioplasty represents a widely available and logistically attractive approach that yields identical short-term and long-term cardiovascular magnetic resonance-derived left ventricular outcome compared to primary angioplasty.

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