A clinical case of the use of systemic thrombolysis with Alteplase after an unsuccessful primary percutaneous coronary intervention in a patient with acute ST-segment elevation myocardial infarction
- Authors: Gavrilko A.D.1, Krasheninin D.V2, Kuslivy A.M2, Shalaev S.V1
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Affiliations:
- Tyumen State Medical University
- Regional Clinical Hospital № 1
- Issue: Vol 27, No 3 (2020)
- Pages: 147-151
- Section: Articles
- URL: https://journals.eco-vector.com/2073-4034/article/view/312623
- DOI: https://doi.org/10.18565/pharmateca.2020.3.147-151
- ID: 312623
Cite item
Abstract
Background. In patients with ECG acute ST-segment elevation myocardial infarction on an electrocardiogram, primary percutaneous coronary intervention is the preferred reperfusion strategy. However, there are a certain percentage of PCI failures that may be related to the complexity of the anatomy of the lesion and the technical problems that arise during the intervention itself. Due to the lack of evidence basis, there are no accurate data that open surgery (coronary artery bypass grafting) in case of unsuccessful coronary intervention will be of potential benefit for the patient, and time delays associated with preparation, in our opinion, could negatively affect outcomes in a patient with acute ST-segment elevation myocardial infarction. Description of the clinical case. This clinical example describes the use of sistemic thrombolysis with Alteplase after an unsuccessful primary percutaneous coronary intervention with a positive clinical effect. Conclusion. Despite the improvement of the stenting technique, there are still a certain percentage of failures of percutaneous coronary intervention, including those related to the inability to deliver the stent to the target area. Thus, the further management strategy for patients with ST-segment elevation myocardial infarction depends primarily on an individual benefit-risk evaluation in a particular clinical situation.
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About the authors
Artem D. Gavrilko
Tyumen State Medical University
Email: artem@gmail.com
X-ray surgeon Tyumen, Russia
D. V Krasheninin
Regional Clinical Hospital № 1Tyumen, Russia
A. M Kuslivy
Regional Clinical Hospital № 1Tyumen, Russia
S. V Shalaev
Tyumen State Medical UniversityTyumen, Russia
References
- Ibanez B., James S., Agewall S. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-77. Doi: 10.1093/ eurheartj/ehx393.
- Zijlstra F., Hoorntje J.C., de Boer M.J., et al. Longterm benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med. 1999;341(19):1413-doi: 10.1056/NEJM199911043411901.
- Keeley E.C., Boura J.A., Grines C.L. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 rand- omised trials. Lancet. 2003;361(9351):13-20. Doi:10.1016/ S0140-6736(03)12113-7.
- Widimsky P, Budesinsky T., Vorac D., et al. ‘PRAGUE' Study Group Investigators. Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction. Final results of the randomized national multicentre trial - PRAGUE-2. Eur Heart J. 2003; 24(1):94-104.
- Andersen H.R., Nielsen T.T, Rasmussen K., et al. DANAMI-2 Investigators. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003;349(8):733-42. Doi: 10.1056/ NEJMoa025142.
- Nikolsky E., Gruberg L., Pechersky S. Stent Catheterizat Cardiovasc Interv. 2003;59:324-28. doi: 10.1002/ccd.10543.
- Seshadri N., Whitlow P.L., Acharya N. Emergency coronary artery bypass surgery in the contemporary percutaneous coronary intervention era. Circulation. 200;106(18):2346-50. doi: 10.1161/01.cir.0000036595.92742.69.
- Yang E.H., Gumina R.J., Lennon R.J. Emergency coronary artery bypass surgery for percutaneous coronary interventions: changes in the incidence, clinical characteristics, and indications from 1979 to 2003. J Am Coll Cardiol 2005;46(11):2004-doi: 10.1016/j.jacc.2005.06.083.
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