Durán NJR, Acuña J, Kuri AM, Sierra FCR, Gaxiola MMBA, Serrano VX

Language: Spanish
References: 18
Page: 97-110
PDF size: 240.85 Kb.

ABSTRACT

Introduction: Acute myocardial infarction remains one of the major causes of mortality worldwide. Recent advances have greatly reduced mortality; however, new challenges arise in the post-reperfusion era. The use of intracoronary thrombolysis arises again as an effective therapy in patients who are taken to angiography showing a significant burden of intracoronary thrombus. Methods: A search was performed in Medline, PubMed, EMBASE, UKCRN and LILACS, obtaining 116 articles that referred to the subject. From this, we got a final conglomerate for the systematic review and meta-analysis of eight articles that met the inclusion criteria, all randomized trials. The following final outcomes were analyzed: death at thirty days, death at a year, major bleeding and change in ejection fraction of the left ventricle. Results and analysis: This review included 1,437 subjects. Early mortality was significantly reduced (OR 0.4, 95% CI 0.245-0.689, p ‹ 0.0001) in patients who underwent intracoronary thrombolysis. The effect persisted in the evaluation at one year (OR 0.52, 95% CI 0.33 to 0.81, p = 0.004). There was a higher frequency of bleeding events in the group of intracoronary thrombolysis, with a strong trend toward statistical significance, but without reaching it (OR 3.6, 95% CI 0.89 to 15.4, p = 0.06). The ejection fraction of the left ventricle was higher in patients who underwent intracoronary thrombolysis (SMD 0.56, CI 0.36-0.76). Conclusions: Intracoronary thrombolysis reduces mortality at one month and at one year, it has a significant impact and magnitude of proper statistical significance without significantly increasing the risk of bleeding. The ejection fraction of the left ventricle, evaluated during hospitalization is higher in patients who were thrombolyzed. With the growing interest among cardiologists in this research area, it is expected that further studies are published, since intracoronary thrombolytic therapies are not well standardized and more evidence is needed.

REFERENCES

1. Nabel E, Braunwald E. A tale of coronary artery disease and myocardial infarction. N Eng J Med. 2012; 366: 54-63.

2. Maroko PR, Kjekshus JK, Sobel BE et al. Factors influencing infarct size following experimental coronary artery occlusion. Circulation. 1971; 43: 67-82.

3. Chazov EI, Mateeva LS, Mazaev AV, Sargin KE, Sadovskaia GV, Ruda MI. Intracoronary administration of fibrinolysin in acute myocardial infarct. Ter Arkh. 1976; 48: 8-19.

4. Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet. 1986; 1: 397-402.

5. ISIS-2 Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet. 1988; 2: 349-60.

6. Grines CL, Browne KF, Marco J et al. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. N Engl J Med. 1993; 328: 673-9.

7. Pfeffer MA, Braunwald E, Moyé LA et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the Survival and Ventricular Enlargement trial. N Engl J Med. 1992; 327: 669-77.

8. Sacks FM, Pfeffer MA, Moyé LA et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels: results of the Cholesterol and Recurrent Events (CARE) trial. N Engl J Med. 1996; 335: 1001-9.

9. Endo A. The discovery and development of HMG-CoA inhibitors. J Lipid Res. 1992; 33: 1569-82.

10. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994; 344: 1383-9.

11. Van der Laerse A, Vermeer F, Hermens W et al. Effects of early intracoronary streptokinase in infarct size estimated from cumulative enzyme release and on enzyme release rate: A randomized trial of 533 patients with acute myocardial infarction. Am Heart J. 1986; 112: 672.

12. Van der Wall E, Van Eenige M, Verheugt F, Wijns W et al. Effects of intracoronary thrombolysis on global left ventricular function assessed by an automated edge detection technique. J Nucl Med. 1986 27: 478-483.

13. Valantine R, Pitts D, Brooks-Brunnn J, Williams J et al. Intravenous versus intracoronary streptokinase in acute myocardial infarction. Am J Cardiol. 1985; 55: 309-312.

14. Tennant S, Dixon J, Venable T, Page HL, Roach A. Intracoronary thrombolysis in patients with acute myocardial infarction: comparison of the efficacy of urokinase with streptokinase. Circulation. 1984; 69: 756-760.

15. Simoons M, Vos J, Tijssen J, Vermeer F, Verheught F et al. Long-term benefit of early thrombolytic therapy in patients with acute myocardial infarction: 5 year follow-up of a trial conducted by the Interuniversity Cardiology Institute of the Netherlands. J Am Coll Cardiol. 1989; 14: 1609-15.

16. Rentrop K, Feit F, Blanke H, Stecy P, Schneider R. Effects of intracoronary streptokinase and intracoronary nitroglycerin infusion on coronary angiographic patterns and mortality in patients with acute myocardial infarction. N Eng J Med. 1984; 311: 1457-63.

17. Kennedy JW, Ritchie J, Davis K, Fritz J. Western Washington randomized trial of intracoronary streptokinase in acute myocardial infarction. N Engl J Med. 1983; 309: 1477-82.

18. Kennedy JW, Ritchie J, Davis K, Stadius M, Maynard C, Fritz J. The Western Washington randomized trial of intracoronary streptokinase in acute myocardial infarction. N Eng J Med. 1985; 312: 1073-8.