... passer directement � l'angioplastie Surtout pas tous le temps et pour tout le monde n'importe o�
Des meilleures nouvelles : Early Revascularization After Thrombolysis Safe After STEMI NEW YORK (Reuters Health) Sept 16 - In patients with ST-segment elevated myocardial infarction (STEMI), early thrombolysis followed shortly thereafter by cardiac catheterization with myocardial revascularization and stent implantation leads to better outcomes than a more conservative approach, physicians in Spain report. Thrombolysis alone is associated with a high rate of failed reperfusion and reocclusion, Dr. Francisco Fernandez-Aviles and colleagues explain in the September 18th issue of The Lancet. Before the current "era of stents and new antiplatelet agents," routine angioplasty soon after thrombolysis was associated with increased risk of complications in STEMI patients. More recently, studies show that stent implantation soon after thrombolysis is safe and prevents reocclusion. Dr. Fernandez-Aviles' group therefore designed the GRACIA-1 trial to evaluate the benefits of an early post-thrombolysis interventional strategy. Five hundred patients with STEMI underwent intravenous thrombolysis with fibrin-specific agents. They were then randomized to coronary angiography and revascularization, if indicated, within 24 hours (n = 248), or an ischemia-guided conservative tactic, in which revascularization was performed only in cases with spontaneous or stress-induced ischemia (n = 252). In the active intervention group, 199 patients underwent stenting of the culprit artery, 51 had non-culprit artery stenting, 6 had coronary bypass surgery, and 41 underwent medical treatment only. In the watchful waiting group, 51 patients required predischarge ischemia-driven revascularization with stenting. Major bleeding rates were 1.6% in each group. By the 30-day mark, 2.4% in each treatment arm had died, while three in the invasive group and four in the conservative group had reinfarction. However, the average index hospital duration was significantly shorter in the invasive group, 7.1 days versus 10.5 days (p = 0.001). After 1 year, the primary combined endpoint of death, nonfatal reinfarction or revascularization was reached by significantly more in the conservative treatment group (21% versus 9%, p = 0.0008). In contrast to balloon angioplasty, stent implantation impedes subintimal hemorrhage and reduces rethrombosis, Dr. Fernandez-Aviles and his associates suggest, which probably explains the outcomes of the GRACIA-1 trial. "Altogether, these findings should affect clinical practice," they conclude. "The strategy of stenting hours after intravenous thrombolysis is applicable to the entire population with acute myocardial infarction." In a related editorial, Dr. Freek W. A. Verheugt, at University Medical Centre in Nijmegen, Netherlands, writes, "The concept of fibrinolysis first and then angioplasty is attractive: Early reperfusion by a widely available strategy to salvage as much myocardium as possible followed by a definitive treatment, angioplasty with stenting, to ensure both reperfusion in case of lytic failure and prevention of reocclusion and reinfarction." Lancet 2004;364:1014-1015, 1045-1053. --- URG-L Si vous avez plusieurs adresses email, vous pouvez les envoyer a Frederic Giroux a l'adresse [EMAIL PROTECTED] Un (ou des) alias pourront ainsi etre crees pour que vous puissiez envoyer des messages a travers la liste a partir de n'importe quel de vos alias. Autrement, les messages qui proviennent d'une adresse non-listee sont automatiquement rejetes.
