Abstract
Ambiguous data about comparability regarding clinical outcomes for prehospital thrombolysis, coupled with timely coronary angiography, and primary percutaneous coronary intervention (PCI) in the early after acute ST-segment elevation myocardial infarction (STEMI), there are now. In the STREAM trial 1892 patients with STEMI diagnosed within 3 hours after onset of symptoms, and whom it was impossible to perform primary PCI within 1 h after the first medical contact, were randomly assigned into two treatment groups: a) primary PCI b) prehospital thrombolytic therapy with bolus tenecteplase (dose decreased by half in patients aged ≥75 years) in combination with clopidogrel and enoxaparin followed by admission to the hospital, where it was possible to perform PCI. Emergency coronary angiography performed if thrombolysis failed. Coronary angiography and PCI of the infarct-related artery were performed in the period from 6 to 24 hours after randomization and thrombolytic therapy in the case of an effective thrombolysis. Primary endpoints include a composite of death, shock, congestive heart failure, or reinfarction up to 30 days. The primary endpoint occurred in 116 of 939 patients (12.4 %) of the thrombolysis group and in 135 of 943 patients (14.3%) of the primary PCI group (relative risk in the group thrombolysis 0.86, 95% confidence interval 0.68-1.09, p=0.21). Emergency angiography was required in 36.3% of patients in the thrombolysis, and the remaining patients, coronary angiography and PCI were performed at a mean of 17 hours after randomization and thrombolytic therapy. Thrombolysis group had more intracranial hemorrhages than primary PCI group (1.0% vs 0.2%, p=0.04; after correction protocol and dose reduction by half of tenecteplase in patients ≥75 years: 0.5% vs. 0.3%, p=0.45). The rate of non- intracranial bleeding in two treatment groups did not differ. Prehospital thrombolysis followed by coronary angiography and timely PCI provide effective reperfusion in patients in the early stages of STEMI that was not possible to carry out primary PCI within 1 h after the first medical contact. Nevertheless, fibrinolysis was associated with a slight increase in the risk of intracranial bleeding.
Highlights
На сегодняшний день имеются противоречивые данные о том, обеспечивает ли догоспитальный тромболизис в сочетании со своевременно выполненным чрескожным коронарным вмешательством (ЧКВ) клинический исход, аналогичный результатам первичного чрескожное коронарное вмешательство (ЧКВ) в ранние сроки от начала возникновения клинической картины острого инфаркта миокарда с подъемом ST-сегмента (ИМпST)
В исследовании STREAM 1892 пациентов с ИМпST, диагностированным в течение 3 ч после появления симптомов, и которым было невозможно сделать первичное ЧКВ в течение 1 ч после первого медицинского контакта, были рандомизировано распределены в две группы лечения: а) первичного ЧКВ, б) тромболитической терапии на догоспитальном этапе с помощью болюсного в/в введения тенектеплазы в комбинации с клопидогрелом и эноксапарином с последующей госпитализацией в стационар, где было возможно выполнение ЧКВ
In the STREAM trial 1892 patients with STEMI diagnosed within 3 hours after onset of symptoms, and whom it was impossible to perform primary PCI within 1 h after the first medical contact, were randomly assigned into two treatment groups: a) primary PCI b) prehospital thrombolytic therapy with bolus tenecteplase in combination with clopidogrel and enoxaparin followed by admission to the hospital, where it was possible to perform PCI
Summary
При невозможности выполнения первичного ЧКВ в установленные Рекомендациями сроки, единственным альтернативным методом реперфузии миокарда у больных ИМпST является тромболитическая терапия (ТЛТ), которая должна проводиться в первые 12 ч от начала заболевания тем больным, которым первичное ЧКВ не может быть выполнено в первые 2 ч после первого медицинского контакта (Класс рекомендаций IA). Именно проблеме фармакоинвазивной стратегии лечения больных с ИМпST посвящено недавно закончившееся исследование STREAM (Strategic Reperfusion Early after Myocardial Infarction), в котором оценивали, обеспечивает ли ТЛТ, включающая догоспитальный тромболизис в комбинации с современными антитромбоцитарными и антикоагулянтными препаратами и своевременной коронарной ангиографией, клинические результаты, сходные с результатами первичного ЧКВ у пациентов с ИМпST, поступающих в стационар вскоре после появления симптомов [4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
