ST elevation myocardial infarction recurrent ischemia/infarction: Difference between revisions
New page: {{SI}} {{CMG}} {{EH}} ==Overview== Reinfarction is defined as a recurrence of a myocardial infarction. The rate of reinfarction following fibrinolytic administration has been es... |
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==Definitions== | ==Definitions== | ||
== | ==Clinical predictors and timing of reinfarction following fibrinolytic administration== | ||
The frequency, timing, and clinical predictors of in-hospital reinfarction were evaluated in the Global Utilization of Streptokinase and Tissue plasminogen activator (alteplase) for Occluded coronary arteries (GUSTO I) and Global Use of Strategies To Open occluded coronary arteries (GUSTO III) populations <ref name="pmid11551872">{{cite journal |author=Hudson MP, Granger CB, Topol EJ, ''et al'' |title=Early reinfarction after fibrinolysis: experience from the global utilization of streptokinase and tissue plasminogen activator (alteplase) for occluded coronary arteries (GUSTO I) and global use of strategies to open occluded coronary arteries (GUSTO III) trials |journal=Circulation |volume=104 |issue=11 |pages=1229–35 |year=2001 |month=September |pmid=11551872 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11551872}}</ref>. Reinfarction developed in in 2,258 out of 55, 911 patients (4.3%). Reinfarction was diagnosed a median of 3.8 days after fibrinolytic administration. The specific fibrinolytic agent administered was not associated with the rate of reinfarction: [[streptokinase]], 4.1%; [[alteplase]], 4.3%; [[reteplase]], 4.5%; combined streptokinase and alteplase, 4.4%; P=0.55. Multivariate predictors or reinfarction included the following: older age, shorter time to fibrinolytic administration, non-US enrollment, nonsmoking status, prior MI or angina, female gender, anterior MI, and lower systolic blood pressure. | The frequency, timing, and clinical predictors of in-hospital reinfarction were evaluated in the Global Utilization of Streptokinase and Tissue plasminogen activator (alteplase) for Occluded coronary arteries (GUSTO I) and Global Use of Strategies To Open occluded coronary arteries (GUSTO III) populations <ref name="pmid11551872">{{cite journal |author=Hudson MP, Granger CB, Topol EJ, ''et al'' |title=Early reinfarction after fibrinolysis: experience from the global utilization of streptokinase and tissue plasminogen activator (alteplase) for occluded coronary arteries (GUSTO I) and global use of strategies to open occluded coronary arteries (GUSTO III) trials |journal=Circulation |volume=104 |issue=11 |pages=1229–35 |year=2001 |month=September |pmid=11551872 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11551872}}</ref>. Reinfarction developed in in 2,258 out of 55, 911 patients (4.3%). Reinfarction was diagnosed a median of 3.8 days after fibrinolytic administration. The specific fibrinolytic agent administered was not associated with the rate of reinfarction: [[streptokinase]], 4.1%; [[alteplase]], 4.3%; [[reteplase]], 4.5%; combined streptokinase and alteplase, 4.4%; P=0.55. Multivariate predictors or reinfarction included the following: older age, shorter time to fibrinolytic administration, non-US enrollment, nonsmoking status, prior MI or angina, female gender, anterior MI, and lower systolic blood pressure. | ||
==Prognosis of reinfarction== | ==Prognosis of reinfarction== | ||
Revision as of 21:34, 4 February 2009
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Overview
Reinfarction is defined as a recurrence of a myocardial infarction. The rate of reinfarction following fibrinolytic administration has been estimated to be 2% to 6%.
Definitions
Clinical predictors and timing of reinfarction following fibrinolytic administration
The frequency, timing, and clinical predictors of in-hospital reinfarction were evaluated in the Global Utilization of Streptokinase and Tissue plasminogen activator (alteplase) for Occluded coronary arteries (GUSTO I) and Global Use of Strategies To Open occluded coronary arteries (GUSTO III) populations [1]. Reinfarction developed in in 2,258 out of 55, 911 patients (4.3%). Reinfarction was diagnosed a median of 3.8 days after fibrinolytic administration. The specific fibrinolytic agent administered was not associated with the rate of reinfarction: streptokinase, 4.1%; alteplase, 4.3%; reteplase, 4.5%; combined streptokinase and alteplase, 4.4%; P=0.55. Multivariate predictors or reinfarction included the following: older age, shorter time to fibrinolytic administration, non-US enrollment, nonsmoking status, prior MI or angina, female gender, anterior MI, and lower systolic blood pressure.
Prognosis of reinfarction
In the combined GUSTO I and III experience, reinfarction was associated with a higher mortality at 30 days(11.3% versus 3.5% without reinfarction; odds ratio, 3.5; P<0.001) and from 30 days to 1 year (4.7% versus 3.2%; hazard ratio, 1.5; P<0.001). Significant multivariate predictors of in-hospital death or reinfarction included older age, higher Killip class, lower systolic and diastolic blood pressures, higher heart rate, the presence of an anterior MI, smoking, a history of prior MI, gender, and country of enrollment (all P<0.001) [1].
- ↑ 1.0 1.1 Hudson MP, Granger CB, Topol EJ; et al. (2001). "Early reinfarction after fibrinolysis: experience from the global utilization of streptokinase and tissue plasminogen activator (alteplase) for occluded coronary arteries (GUSTO I) and global use of strategies to open occluded coronary arteries (GUSTO III) trials". Circulation. 104 (11): 1229–35. PMID 11551872. Unknown parameter
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