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Tarunjit Singh Department of Internal Medicine Westchester Medical Center New York Medical College Valhalla NY

Tarunjit Singh Department of Internal Medicine Westchester Medical Center New York Medical College Valhalla NY.

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Tarunjit Singh Department of Internal Medicine Westchester Medical Center New York Medical College Valhalla NY

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  1. Tarunjit Singh Department of Internal Medicine Westchester Medical Center New York Medical College Valhalla NY Major Adverse Cardiac Event Rates after Bare- Metal Stenting Versus Drug-Eluting Stenting in Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Thrombolysis and Percutaneous Coronary Intervention

  2. Aims and Objectives • To compare Major Adverse Cardiac Events (MACE) in Bare- metal versus drug-eluting stent in patients treated with TNK prior to being admitted to our facility for PCI.

  3. Major Adverse Cardiac events (MACE) Defined as occurrence of one of the following : • Myocardial Infarction • Target Vessel Revascularization • Death

  4. Introduction Prehospital Fibrinolysis • Improvement in survival • Smaller infarct size • Improved ventricular healing • Reduction in the extent of left ventricular dysfunction • Greater electrical stability

  5. Fibrinolytic Agents And Trials • GISSI-2 and ISIS-2 – Streptokinase • GUSTO-I trial – Alteplase • GUSTO III trial compared Reteplase with Alteplase • ASSENT-2 compared Tenecteplase to Alteplase • The net effect in major thrombolytic trials has been an approximately 30 percent reduction in short-term mortality to a value of 7 to 10 percent.

  6. Time to thrombolysis and 35-day mortality

  7. PCI after fibrinolysis • There are three settings in which Percutaneous Coronary Intervention (PCI) is performed after fibrinolysis: • Facilitated PCI, in which a fibrinolytic drug is given prior to planned PCI in an attempt to achieve an open infarct-related artery before arrival in the catheterization laboratory • Rescue / Salvage PCI is defined as PCI performed within 12 hours of failed fibrinolysis (primary failure) in patients with evidence of continuing or recurrent myocardial ischemia

  8. Methods • Analysis of 376 consecutive patients ,out of which 102 received BMS and 274 received DES from 2003 to 2005. • The 376 patients were followed for a period of 43± 17 months. • End point of follow-up was occurrence of MACE. • Choice of stent type was at the discretion of the operator. • Chi-square or Fisher’s exact test were done for categorical variables. • Student’s T test were done for continuous variables.

  9. Results

  10. Results

  11. Cardiac Catheterization findings

  12. Cardiac Catheterization findings

  13. Incidence of MACE

  14. Cox Regression analysis for independent prognostic factors for MACE

  15. RESULTS • Prior CABG surgery, Decreased stent width and the use of bare-metal stents (BMS) were independent risk factors for MACE. • BMS had a 1.8 times higher incidence of developing MACE as compared to DES. • No increased rate of acute or chronic thrombosis after thrombolysis in either group. The increased rate of MACE in BMS group may be attributed to increased incidence of restenosis.

  16. THANK YOU

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