p0 001 p0 03 The GUSTO Trial Results

Η Θρομβόλυση στο ΟΕΜ p<0. 001 p<0. 03 The GUSTO Trial Results. Clin Res. 1993; 41: 207 -8.

Σχέση TIMI Ροής (90 min) και Θνητότητας p=0. 009 Simes, Circulation 1995.

Σύγκριση Ροής ΤΙΜΙ 3 μεταξύ t. PA-SK p<0. 001 p=NS N Engl J Med 1993; 329: 1615 -22.

Σύγκριση t. PA-r. PA p<0. 05 p=NS Circulation 1996; 94: 891 -9 & N Engl J Med 1997; 337; 1118 -23.

NOVEL CONCEPTS Overcoming Thrombolytic Resistance Fibrin Platelets Plasminogen activators - t-PA - r-PA - TNK-t. PA Antiplatelet therapy - aspirin - GP IIb/IIIa inhibitors - dihydropyridines Thrombin J Am Coll Card 1999; 34: 1395 -402. Antithrombin therapy - heparin - LMWH

Μελέτη GUSTO IIb: Αγγειοπλαστική vs Θρομβόλυση • NNT for avoiding 1 death=76 • NNT for avoiding 1 event (death/MI/CVA)=25 N Engl J Med 1997; 336: 1621 -8.

Μελέτη PAMI-1 STEMI J Am Coll Cardiol 1999; 33: 640 -6.

Μελέτη Stent-PAMI: Ο Ρόλος του Stenting Grines et al. N Engl J Med 1999; 341: 1949 -56.

Η Χρήση Αναστολέων GP IIb/IIIa στο ΟΕΜ: Μελέτη CADILAC Hypothesis: Stenting was superior to PTCA and not inferior to PTCA+Abciximab with respect to composite end point. P values compare abciximab vs. non-abciximab groups. N Engl J Med 2002; 346: 957 -66.

DANAMI-2 (30 day Death/MI/Stroke) p=0. 002 p<0. 001 p=0. 05 Andersen at al. N Engl J Med 2003; 349: 733 -42.

Χρόνος Διάνοιξης Αρτηρίας στις Μελέτες Ασθενών με ΟΕΜ Μελέτη Χρόνος Διάνοιξης (min) MAASTRICHT 85 PRAGUE-1 80 AIR-PAMI* 122 CAPTIM 82 DANAMI-2 90 PRAGUE-2 97 Circulation 2003; 108: 1809 -1814.

Η Μελέτη PACT Ross et al. J Am Coll Cardiol 1999; 34: 1954 -62.

Μελέτη PACT: TIMI 3 Ροή p<0. 001 J Am Coll Cardiol 1999; 34: 1954 -62.

Αποτελεσματικότητα και Ασφάλεια: GUSTO-5 p=NS p<0. 001 p=NS p=0. 07 Lancet 2001; 357: 1905 -14.

Αποτελεσματικότητα: ASSENT-3 Lancet 2001; 358: 605 -13.

Αποτελεσματικότητα και Ασφάλεια: TIMI 10 B & TIMI 14 Schweiger et al. Am J Cardiol 2001; 88: 831 -6.

Η Μελέτη SIAM: Αποτελέσματα στις 30 Ημέρες p=0. 001 p=NS J Am Coll Cardiol 2003; 42: 634 -41.

Methods-Study Population AHA, New Orleans 2004

Baseline TIMI 3 flow comparisons P<0. 001 AHA, New Orleans 2004

In-hospital mortality P=0. 04 AHA, New Orleans 2004

Comparison of in-hospital MACE* P=0. 003 * MACE: Death/Re-infarction/Emergent revascularization/Stroke AHA, New Orleans 2004

STEMI TRSF subgroup analysis: Baseline TIMI 3 flow based on specific treatment P<0. 001 for trend AHA, New Orleans 2004

STEMI TRSF subgroup analysis: In-hospital Death and MACE results based on specific treatment P=0. 03 for trend P=0. 13 for trend AHA, New Orleans 2004

Figure 6: Ιn-hospital TIMI Major and Minor bleeding rates P=NS AHA, New Orleans 2004

Facilitated PCI Improves Οutcomes Ιrrespective of DTB Time Papaioannou et al. J Am Coll Cardiol 2005; 45: 139 A

FINESSE Trial Design

Reperfusion Options for STEMI patients Step One: Assess Time and Risk Time Since Symptoms Risk of STEMI Risk of Lysis Time Required to Initiate Invasive Strategy

Patient Current Onset of MI Transport Patient response Door Inhospital Data Decision Reperfusion Drug Started Flow Restored Fibrinolysis Cath PCI Primary PCI Goal 5 min D-N < 30 min D-B < 90 min Media campaign Patient education Greater use of 911 Prehospital ECG Prehospital Rx MI protocol Critical Pathway Quality Imp. Program Bolus Lytics Dedicated PCI Team Methods of Speeding Time to Reperfusion