Intracoronary tenecteplase versus abciximab as adjunctive treatment during primary percutaneous coronary intervention in patients with anterior myocardial infarction.

AIMS: We sought to compare the effects of intracoronary administration of a fibrinolytic drug (tenecteplase) to those of a glycoprotein IIb/IIIa inhibitor (abciximab) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS AND RESULTS: In this pilot trial, 76 patients (59 male) with anterior STEMI were randomised to intracoronary infusion of reduced-dose tenecteplase or abciximab during PPCI. Angiography was repeated at 48 hours to assess corrected TIMI frame count (cTFC) and TIMI myocardial perfusion grade (TMPG). The primary endpoint was infarct size as assessed by cardiac MRI. The abciximab group showed lower cTFC (median 14.1 [IQR 9.4-17.1]) than the tenecteplase group (18.2 [10.0-28.2]) (p=0.02), and the proportion of patients with TMPG grade 2/3 was higher in the abciximab group (90.3% vs. 67.7%; p=0.03). Major cardiac and cerebrovascular event rates did not differ; however, notably, 2/38 patients in the tenecteplase group experienced subacute stent thrombosis. At four months, there were no significant differences in infarct size between the tenecteplase and abciximab groups (17.0 g [9.6-27.5] vs. 21.1 g [11.3-35.0], p=0.33). CONCLUSIONS: Intracoronary administration of tenecteplase did not reduce infarct size compared to abciximab in STEMI patients undergoing PPCI. Tenecteplase exhibited poorer myocardial reperfusion and might be associated with increased subacute stent thrombosis.

[Previous restenosis as a prognostic indicator in new conventional stent implantation at a different location]. / El comportamiento reestenótico previo como predictor pronóstico ante nueva implantación de stent convencional en distinta localización.

INTRODUCTION AND OBJECTIVES: The aim was to determine whether data on restenosis of a previous stent are useful for predicting outcome in patients who need to undergo a second conventional stent implantation at a different location because of coronary disease progression. METHODS: The study included 80 patients who, during 2000-2004, underwent a second conventional (i.e., not drug-eluting) stent implantation for de novo lesions at a different location to that of the previous stent. Major adverse cardiac events (MACE) were defined as death, non-fatal myocardial infarction, or the need for target lesion revascularization (TLR). RESULTS: One year after the second procedure, the cumulative incidence of MACE was significantly higher in patients who experienced significant restenosis of the previous stent than in those who did not (40.6% vs 12.5%, P=.004). Univariate predictors of MACE were: evidence of previous stent restenosis, previous myocardial infarction, and a small vessel (< or =2.75 mm). However, the only independent predictor (Cox regression) of a MACE was previous stent restenosis (hazard ratio 3.85, 95% confidence interval, 1.46-10.18; P=.007). At one year, the TLR rate was also higher in patients with previous stent restenosis (31.3% vs 8.3%; P=.008), in those with small vessels, and in diabetics. Previous stent restenosis and a small vessel were independent predictors of TLR. CONCLUSIONS: Restenosis of a previous stent is a strong predictor of major adverse events in patients undergoing a second conventional stent implantation at a different location because of coronary disease progression.

El comportamiento reestenótico previo como predictor pronóstico ante nueva implantación de stent convencional en distinta localización / Previous restenosis as a prognostic indicator in new conventional stent implantation at a different location

Introducción y objetivos. Averiguar si, en pacientes que requieren un segundo procedimiento de implante de stent convencional en una nueva localización por progresión de enfermedad coronaria, la información aportada por la respuesta reestenótica frente al stent previo es útil para predecir la evolución. Métodos. Se incluye a los 80 pacientes que recibieron un segundo procedimiento de implante de stent convencional (no farmacoactivo) sobre lesiones de novo de distinta localización de la del stent previo en el período 2000-2004. Se definió como evento mayor la ocurrencia de muerte, infarto no mortal o necesidad de revascularización de la lesión diana de novo (RLD). Resultados. Al año del segundo procedimiento, los pacientes que habían evidenciado reestenosis significativa del stent del procedimiento previo tuvieron una incidencia de eventos mayores superior a los pacientes sin reestenosis previa (el 40,6 frente al 12,5%; p = 0,004). Los predictores univariables de eventos mayores fueron la evidencia de reestenosis previa, el infarto previo, y el vaso pequeño (<= 2,75 mm), aunque el único predictor independiente de eventos (regresión de Cox) fue la reestenosis previa (hazard ratio = 3,85; intervalo de confianza del 95%, 1,46-10,18; p = 0,007). La RLD al año fue también mayor en los pacientes con reestenosis previa (el 31,3 frente al 8,3%; p = 0,008), en vasos pequeños y en diabéticos, siendo predictores independientes los dos primeros. Conclusiones. El comportamiento reestenótico frente a un stent previo es un potente predictor de eventos mayores en pacientes que reciben un segundo procedimiento de implante de stent convencional en distinta localización por progresión de su enfermedad coronaria (AU)

Introduction and objectives. The aim was to determine whether data on restenosis of a previous stent are useful for predicting outcome in patients who need to undergo a second conventional stent implantation at a different location because of coronary disease progression. Methods. The study included 80 patients who, during 2000-2004, underwent a second conventional (i.e., not drug-eluting) stent implantation for de novo lesions at a different location to that of the previous stent. Major adverse cardiac events (MACE) were defined as death, non-fatal myocardial infarction, or the need for target lesion revascularization (TLR). Results. One year after the second procedure, the cumulative incidence of MACE was significantly higher in patients who experienced significant restenosis of the previous stent than in those who did not (40.6% vs 12.5%, P=.004). Univariate predictors of MACE were: evidence of previous stent restenosis, previous myocardial infarction, and a small vessel (<=2.75 mm). However, the only independent predictor (Cox regression) of a MACE was previous stent restenosis (hazard ratio 3.85, 95% confidence interval, 1.46-10.18; P=.007). At one year, the TLR rate was also higher in patients with previous stent restenosis (31.3% vs 8.3%; P=.008), in those with small vessels, and in diabetics. Previous stent restenosis and a small vessel were independent predictors of TLR. Conclusions. Restenosis of a previous stent is a strong predictor of major adverse events in patients undergoing a second conventional stent implantation at a different location because of coronary disease progression (AU)

La ecocardiografía en el paciente con accidente cerebrovascular: un problema pendiente / Echocardiography in stroke: a pending problem

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