Background: Primary percutaneous coronary intervention (PCI) has emerged as the preferred therapy for acute ST-elevation myocardial infarction (STEMI) provided it is performed in a timely fashion at an expert 24/7 facility. Fibrinolysis is a well-accepted alternative, especially in patients presenting early after symptom onset. The STREAM study will provide novel information on whether prompt fibrinolysis at first medical contact, followed by timely catheterization or rescue coronary intervention in STEMI patients presenting within 3 hours of symptom onset, represents an appropriate alternative strategy to primary PCI. Methods: Acute STEMI patients presenting early after symptom onset are eligible if PCI is not feasible within 60 minutes of first medical contact. This is an open-label, prospective, randomized, parallel, comparative, international multicenter trial. Patients are randomized to fibrinolysis combined with enoxaparin, clopidogrel, and aspirin, and cardiac catheterization within 6 to 24 hours or rescue coronary intervention if reperfusion fails within 90 minutes of fibrinolysis versus PCI performed according to local guidelines. Composite efficacy end points at 30 days include death, shock, heart failure, and reinfarction. Safety end points include ischemic stroke, intracranial hemorrhage, and major nonintracranial bleeding. Follow-up is extended to 1 year and includes all-cause mortality. Discussion: Continuing delays in achieving timely PCI remain a difficult issue. Many patients fail to achieve the desired reperfusion times of 90 to 120 minutes after first medical contact. The STREAM results will provide useful additional data on which to base informed therapeutic decisions. © 2010, Mosby, Inc. All rights reserved.

Armstrong, P., Gershlick, A., Goldstein, P., Wilcox, R., Danays, T., Bluhmki, E., et al. (2010). The Strategic Reperfusion Early After Myocardial Infarction (STREAM) study. AMERICAN HEART JOURNAL, 160(1), 30-35 [10.1016/j.ahj.2010.04.007].

The Strategic Reperfusion Early After Myocardial Infarction (STREAM) study

PESENTI, ANTONIO MARIA
2010

Abstract

Background: Primary percutaneous coronary intervention (PCI) has emerged as the preferred therapy for acute ST-elevation myocardial infarction (STEMI) provided it is performed in a timely fashion at an expert 24/7 facility. Fibrinolysis is a well-accepted alternative, especially in patients presenting early after symptom onset. The STREAM study will provide novel information on whether prompt fibrinolysis at first medical contact, followed by timely catheterization or rescue coronary intervention in STEMI patients presenting within 3 hours of symptom onset, represents an appropriate alternative strategy to primary PCI. Methods: Acute STEMI patients presenting early after symptom onset are eligible if PCI is not feasible within 60 minutes of first medical contact. This is an open-label, prospective, randomized, parallel, comparative, international multicenter trial. Patients are randomized to fibrinolysis combined with enoxaparin, clopidogrel, and aspirin, and cardiac catheterization within 6 to 24 hours or rescue coronary intervention if reperfusion fails within 90 minutes of fibrinolysis versus PCI performed according to local guidelines. Composite efficacy end points at 30 days include death, shock, heart failure, and reinfarction. Safety end points include ischemic stroke, intracranial hemorrhage, and major nonintracranial bleeding. Follow-up is extended to 1 year and includes all-cause mortality. Discussion: Continuing delays in achieving timely PCI remain a difficult issue. Many patients fail to achieve the desired reperfusion times of 90 to 120 minutes after first medical contact. The STREAM results will provide useful additional data on which to base informed therapeutic decisions. © 2010, Mosby, Inc. All rights reserved.
Articolo in rivista - Articolo scientifico
Thrombolytic Therapy; Ticlopidine; Humans; Aged; Fibrinolytic Agents; Cause of Death; Enoxaparin; Drug Therapy, Combination; Prospective Studies; Survival Rate; Aspirin; Electrocardiography; Myocardial Reperfusion; Treatment Outcome; Follow-Up Studies; Platelet Aggregation Inhibitors; Time Factors; Myocardial Infarction; Heart Catheterization;
English
30
35
6
Armstrong, P., Gershlick, A., Goldstein, P., Wilcox, R., Danays, T., Bluhmki, E., et al. (2010). The Strategic Reperfusion Early After Myocardial Infarction (STREAM) study. AMERICAN HEART JOURNAL, 160(1), 30-35 [10.1016/j.ahj.2010.04.007].
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/33320
Citazioni
  • Scopus 70
  • ???jsp.display-item.citation.isi??? 61
Social impact