AMI  1979-2001

PowerPoint slides on Clinical Trial Results
Editor-in-Chief: C. Michael Gibson, M.D.
http://www.clinicaltrialresults.org/
www.timi.org , www.timi.tv ,  & www.perfuse.org 
The access to this Website is free and unrestricted. The primary target audience is cardiologists, allied healthcare professionals (such as nurses and lab technicians), internests, family practitioners and primary care physicians. Clinical Trial Results . org is an organization of clinical trial researchers whose goal is to rapidly disseminate emerging clinical trial results to physicians & other health care professionals so that they in turn can educate their colleagues and patients with the ultimate goal of accelerating the delivery of newer treatments. PowerPoint slides can be donwloaded for free.   www.timi.org  and www.timi.tv  strives to have the most up to date and accurate data.

ESC 2001 Meeting Coverage

• CAPTIM (Comparison of Angioplasty and Prehospital Thrombolysis In acute Myocardial Infarction)
• Adjunctive treatment after thrombolysis in acute myocardial infarction: Hopes and Hypes
• Hot Line I: Acute Myocardial Infarction
• Hot Line II : Coronary artery disease and percutaneous coronary intervention. The PCI-CURE and TRUST Studies

Webcasts recorded during the
ESC XXIII Congress - STOCKHOLM 2001

Hot Line 1 : Acute Myocardial Infarction
http://www.prous.com/esc2001/program.asp?xyp=2
Contents
The ESCAMI Study
The CAPTIM Study
The GUSTO V Study
The ASSENT-3 Study
The HERO-2 Study
The WARIS-II Study

Highlight Session
http://www.prous.com/esc2001/program.asp?xyp=3
Contents
Interventional Cardiology
Myocardial Infarction

TCT 2001 Abstracts

TCT 2001 Expert Presentations

Beyond TIMI-3 Flow: TCT 2001 Expert Presentations 

• Discrete and Continuous ST Segment Monitoring to Assess Reperfusion Success, by J. de Lemos
• Myocardial Contrast Echocardiography: Comparison with Alternative Modalities to Predict LV Recovery, by R. Hoffman
• The Illusion of Reperfusion - Focus on the Microvasculature and End-Organ Metabolism, by B.J. Gersh
• Validation of Myocardial Blush in a Mixed High Risk Interventional Population, by A.J. Lansky

CCT 2001 The Book
Chapter 15. Direct stenting for AMI

•  kijima15.PDF (about 1MB)

AVAILABLE FOR SELF-PACED LEARNING
"Highlights of the 16th GWU International Symposium"
http://www.theheart.org/index.cfm?doc_id=21537
Dr Allan Ross of George Washington University discusses the management of occluded coronary arteries with the symposium's original presenters, Drs Sorin Brener, Michael Gibson, David Holmes, and Douglas Weaver.
[supported by an unrestricted educational grant from Genentech]

AVAILABLE FOR SELF-PACED LEARNING
A new paradigm for the treatment of AMI patients
http://www.theheart.org/index.cfm?doc_id=24043 
Original netcast: July 18, 2001; release date: August 3, 2001; expiration date: August 3, 2002
Investigators Drs A Michael Lincoff, Gilles Montalescot, and Eric J Topol review the history and the development of fibrinolysis, adjunctive medications, and percutaneous intervention in AMI. 
[This activity has been approved for AMA PRA credit by the Institute for Continuing Healthcare Educatio]

September 4, 2001
AMI with thrombolysis: interpretation of new clinical data with antithrombotics
http://www.theheart.org/index.cfm?doc_id=24955
Drs Eric J Topol, Frans J Van de Werf, and Harvey White discuss the most recent clinical data on anticoagulation in the management of AMI patients.

THE TREATMENT OF CORONARY HEART DISEASE: AN UPDATE: PART 5: SELECTED COMMENTS AND QUESTIONS
Vasospasm is probably the cause of myocardial infarction (MI) in only a few cases.
Current Medical Research and Opinion 17(1):41-42, 2001
http://cardiology.medscape.com/42223.rhtml?srcmp=card-083101

Primary angioplasty versus intravenous thrombolysis in acute myocardial infarction: 
can we define subgroups of patients benefiting most from primary angioplasty? 
Results from the pooled data of the Maximal Individual Therapy in Acute Myocardial Infarction Registry and the Myocardial Infarction Registry
Zahn R, et al.
J Am Coll Cardiol 2001;37:1827-35
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11401118 
Read Comment

Review
THROMBOLYSIS FOR ACUTE MYOCARDIAL INFARCTION: DRUG REVIEW
Does thrombolysis after AMI improve survival rates? A review of data from The National Registry of Myocardial Infarction.
MedGenMed, January 2, 2002
http://cardiology.medscape.com/46730.rhtml?srcmp=card-010402

Education in Heart 
Acute myocardial infarction: primary angioplasty 
Zijlstra F. Heart 2001;85:705-9 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11359760 
Although more research is required into many facets of primary angioplasty, it is clear that this treatment is here to stay. Planning for infarct angioplasty needs to be coordinated and clinical protocols agreed by all involved in the care of patients with acute myocardial infarction. The additional benefits and limitations of new drugs, devices, and combinations of both will be investigated and may lead to improved patient outcome, but in the years to come, most benefit for our patients will come from dedicated application of the therapeutic possibilities that are available today.

Primary stent implantation compared with primary balloon angioplasty for acute myocardial infarction: 
a meta-analysis of randomized clinical trials 
Zhu MM, et al. 
Am J Cardiol 2001;88:297-301 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11472712

Interventional procedures in acute myocardial infarction
Degeare VS, et al.
Am Heart J 2001;141:15-24.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11136482

<Review>
Acute myocardial infarction: failed thrombolysis
de Belder MA
Heart 2001;85 104-112 
Click here to view the full article
Currently, most patients are treated with either thrombolytic agents or primary angioplasty. Thrombolytic agents on their own do well but not well enough. The re-establishment of coronary flow helps many patients, but for others these agents either do not restore flow, or do it too slowly. Patients with the diagnosis of "failed thrombolysis" fare badly, even if it is diagnosed early (one hour after onset of treatment). A number of methods are available to identify these patients, and although they are imprecise, a convenient and easy-to-use method is to examine the ST segments on the standard 12 lead ECG.

GLYCOPROTEIN IIB/IIIA ANTAGONISTS EFFECTIVE IN AMI PATIENTS WHO FAIL THROMBOLYSIS
Glycoprotein IIb/IIIa receptor antagonists appear to be safe and effective in inducing reperfusion in patients with acute myocardial infarction (AMI) who have failed thrombolysis, according to the results of a pilot study conducted by Italian researchers.
http://cardiology.medscape.com/42975.rhtml?srcmp=card-092801 

Primary angioplasty versus no reperfusion therapy in patients with acute myocardial infarction and a pre-hospital delay of > 12-24 hours: 
Results from the pooled data of the maximal individual therapy in acute myocardial infarction (MITRA) registry and the myocardial infarction registry (MIR)
Zahn R, et al.
J Invasive Cardiol 2001;13:367-72
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11385150 
Current recommendations of the American Heart Association, the American College of Cardiology and the European Heart Association on the therapy of patients with acute myocardial infarction (AMI) suggest initiation of reperfusion therapy, i.e., thrombolysis or primary angioplasty, in AMI patients presenting within 12 hours after the onset of symptoms. http://cardiology.medscape.com/39732.rhtml?srcmp=card-062901

How late is too late (for infarct angioplasty)?
In this issue of the Journal, Zahn and colleagues re-raise an important question in the management of patients with acute myocardial infarction: do those presenting 12-24 hours after symptom onset benefit from reperfusion therapy using angioplasty or stenting?
J Invas Cardiol 13(5):373-374, 2001
http://cardiology.medscape.com/39627.rhtml?srcmp=card-062901

Effect of audit on door-to-inflation times in primary angioplasty/stenting for acute myocardial infarction
Ward MR, et al.
Am J Cardiol 2001;87:336-8, A9
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11165972
The Authors of this study found that after audit and physician-guided changes in their protocol, the door-to-inflation times for primary angioplasty/stenting were markedly reduced. Because our preaudit mean time was similar to the national average, this may have wide applicability.

Early Coronary Angioplasty for Acute Myocardial Infarction: Predictors of a Poor Outcome in a Non-Selected Population
Raúl Moreno et al
J Invas Cardiol 13(3):202-210, 2001
http://cardiology.medscape.com/37771.rhtml?srcmp=card-051801 
The objective of this study was to report the experience in the treatment of acute myocardial infarction (AMI) with early coronary angioplasty (PTCA) in a single European center during one decade, attempting to identify the characteristics associated with a poor prognosis in these patients.
In most cases, PTCA performed in a non-selected patient population with AMI results in angiographic success. Mortality especially occurs in patients who are in cardiogenic shock at the beginning of the procedure. We have observed an improvement in the results throughout the course of the decade.

The late open artery hypothesis--a decade later
Sadanandan S, et al.
Am Heart J 2001;142:411-21
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11526353
This report reviews the data on the potential mechanisms and benefits of late reperfusion and presents prospective data on the incidence of and current practice patterns for the management of persistently occluded infarct-related arteries late after myocardial infarction.The hypothesis that late reperfusion by percutaneous coronary intervention days to weeks after myocardial infarction results in improved long-term clinical outcomes in asymptomatic patients with occluded infarct-related artery is currently being tested in the randomized, multicenter Occluded Artery Trial.

Impact of prehospital delay on mortality in patients with acute myocardial infarction treated with primary angioplasty and intravenous thrombolysis
Zahn R, et al.
Am Heart J 2001;142:105-11
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11431665 

Normal flow (TIMI-3) before mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarction trials
Stone GW, et al.
Circulation 2001;104:636-41
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11489767
Patients undergoing primary PTCA in whom TIMI-3 flow is present before angioplasty present with greater clinical and angiographic evidence of myocardial salvage, are less likely to develop complications related to left ventricular failure, and have improved early and late survival.

Editorial
Importance of TIMI 3 flow
Cannon CP.
Circulation 2001;104:624-6
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11489764

Admission troponin T level predicts clinical outcomes, TIMI flow, and myocardial tissue perfusion after primary percutaneous intervention for acute ST-segment elevation myocardial infarction
Giannitsis E, et al.
Circulation 2001;104:630-5
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11489766
cTnT predicts poorer clinical outcomes, lower rates of postprocedural TIMI 3 flow, and more severely compromised myocardial perfusion despite normal epicardial flow. Thus, a cTnT-positive patient may require more aggressive adjunctive therapy when treated by percutaneous coronary

Editorial
Troponisms, necrosettes, enzyme leaks, creatinine phosphokinase bumps, and infarctlets: what's behind this new lexicon and what does it add?
Holmes DR, Jr., et al.
Circulation 2001;104:627-9
http://www.circulationaha.org/cgi/content/full/104/6/627

Volume-outcome relation for physicians and hospitals performing angioplasty for acute myocardial infarction in new york state
Vakili BA, et al.
Circulation 2001;104:2171-6
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11684626 

Editorial
Operator Volume and Clinical Outcomes of Primary Coronary Angioplasty for Patients With Acute Myocardial Infarction
Mark A. Hlatky and R. Adams Dudley
Circulation 2001;104 2155-2157
http://circ.ahajournals.org/cgi/content/full/104/18/2155

Importance of time to reperfusion on outcomes with primary coronary angioplasty for acute myocardial infarction (results from the Stent Primary Angioplasty in Myocardial Infarction Trial)
Brodie BR, et al.
Am J Cardiol 2001;88:1085-90
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11703949 

Direct infarct artery stenting without predilation and no-reflow in patients with acute myocardial infarction
Antoniucci D, et al.
Am Heart J 2001;142:684-90
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11579360 

Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction
Montalescot G, et al. for the ADMIRAL Investigators
N Engl J Med 2001;344:1895-903
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11419426  Comment-1 

ACC Current Journal Review Sep/Oct 2001
Stenting vs. thrombolysis in acute myocardial infarction trial (STAT)
M.R. Le May, M. Labinaz, R. Davies
pages 59
Abstract | Journal Format-PDF (50Kb)

UPDATE ON STRATEGIES TO IMPROVE THROMBOLYSIS FOR ACUTE MYOCARDIAL INFARCTION
Therapy for acute myocardial infarction involves rapid restoration of blood flow through a coronary artery that has been occluded by a ruptured atherosclerotic plaque.
Pharmacotherapy 21(6):691-716, 2001
http://cardiology.medscape.com/39925.rhtml?srcmp=card-070601

BOLUS ADMINISTRATION FURTHER ENHANCES ROLE OF THROMBOLYTICS IN INITIAL MANAGEMENT OF MYOCARDIAL INFARCTION
Thrombolytic therapy is a routine approach to management of acute myocardial infarction (AMI).
Drug and Ther Perspect 17(9):9-12
http://cardiology.medscape.com/39886.rhtml?srcmp=card-070601

Initial experience with multivessel percutaneous coronary intervention during mechanical reperfusion for acute myocardial infarction
Roe MT, et al.
Am J Cardiol 2001;88:170-3, A6
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11448417 
Patients who underwent multivessel coronary intervention had a higher risk of adverse clinical outcomes through 6 months compared with matched controls in whom coronary intervention was limited to the infarct-related artery.

Sex-based differences in early mortality of patients undergoing primary angioplasty for first acute myocardial infarction
Vakili BA, et al.
Circulation 2001;104:3034-8
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11748096
After correcting for age and baseline risk differences, women undergoing primary angioplasty for AMI have a significantly higher in-hospital mortality rate than men.

Sex-based differences in clinical and angiographic outcomes after primary angioplasty or stenting for acute myocardial infarction
Antoniucci D, et al.
Am J Cardiol 2001;87:289-93
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11165962
This study suggests that sex is not an independent predictor of mortality after primary angioplasty for AMI, and that the benefit of primary stenting is similar in men and women.

Primary angioplasty for acute myocardial infarction in octogenarians
Matetzky S, et al.
Am J Cardiol 2001;88:680-3
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11564397

Cost-effectiveness of coronary stenting in acute myocardial infarction: results from the stent primary angioplasty in myocardial infarction (stent-PAMI) trial
Cohen DJ, et al.
Circulation 2001;104:3039-45
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11748097
As performed in Stent-PAMI, primary stenting for AMI increased 1-year medical care costs compared with primary PTCA. The overall cost-effectiveness of primary stenting depends on the societal value attributed to avoidance of symptomatic restenosis, as well as on the relative mortality rates of primary PTCA and stenting. 

Predictors and prognosis of suboptimal coronary blood flow after primary coronary angioplasty in patients with acute myocardial infarction
Cura FA, et al.
Am J Cardiol 2001;88:124-8
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11448407
Angiographic evidence of thrombus and 2 pivotal clinical characteristics, advanced age and elevated heart rate, predict lack of adequate coronary reperfusion. Conversely, the presence of normal or near-normal coronary flow before intervention correlates with a good angiographic result. Mortality risk is increased in patients with postprocedural suboptimal angiographic coronary flow.

Usefulness of the rescue PT catheter to remove fresh thrombus from coronary arteries and bypass grafts in acute myocardial infarction 
van Ommen V, et al. 
Am J Cardiol 2001;88:306-8 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11472715

Review 
PCI in Acute Myocardial Infarction
  By Antoniucci D
  Click here to view the full article
The Florence experience (1995-2000). Logistic, clinical and angiographic variables which may affect patient outcome. Systematic use of stents. Role of GP IIb/IIIa receptor blockers and other adjunctive therapies. Mechanical approaches to reduce microvascular embolization.

A Comparative Analysis of Primary Stenting and Optimal Balloon Coronary Angioplasty in Acute Myocardial Infarction. Six Month Results from the STENT PAMI Trial  
  Mattos LA || Boura J on the behalf of the Investigators of the STENT PAMI Study 
  Arq. Bras. Cardiol. vol.75 n.6 São Paulo Dec. 2000
  Click here to view the full article (in PDF format Click here) 
At the 6 month follow-up, primary stenting offered the lowest restenosis and ischemia-driven TVR rates. Compared to optimal balloon PTCA. Nonoptimal primary balloon PTCA pts (SD=31-50%), had the worst late angiographic outcomes and should be treated more actively with coronary stent implantation. 

Late-Breaking Clinical Trial 
CADILLAC Trial (Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications)
  Stone GW Presented at the TCT 2000 Meeting
  Click here to view the full article       Click here for additional Comments 
CADILLAC: Make Stenting the Default Therapy - Trends towards poor patency of the infarct-related artery and decreased survival observed in the PAMI Stent trial did not re-emerge in CADILLAC, a large-scale trial of stenting versus angioplasty in acute MI patients. MACE was lower for stenting alone than for any other treatment, including combinations of angioplasty and abciximab or stenting and abciximab. Gregg Stone, M.D., the principal investigator for the trial, concluded that the default reperfusion therapy at centers experienced in interventional management of AMI should be stenting.

Click here to view the full article.

Click here for an abbreviated slide set presented at TCT 2000

TCT 2000 Expert Presentations

• Early and Late Results of IIb/IIIa Inhibitors During Stenting for AMI:
  Insights from Stent PAMI and CADILLAC
     by Grines C MD Click here to view the slides

A randomized study of intravenous magnesium in acute myocardial infarction treated with direct coronary angioplasty
  Santoro GM et al.
  Am Heart J 2000;140:891-897
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011099993 
Intravenous magnesium delivered before, during, and after reperfusion did not decrease myocardial damage and did not improve the short-term clinical outcome in patients with acute myocardial infarction treated with direct angioplasty.

Short- and long-term mortality for patients undergoing primary angioplasty for acute myocardial infarction
  Hannan EL, et al.
  J Am Coll Cardiol 2000;36:1194-201
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011028470 
  Click here to view the slide    Click here to view the synopsis

AHA 2000 Meeting Coverage

• C-PORT Confirms - In Primary PCI, Experience Counts and Surgical Backup Isn't Needed
    by Thomas Aversano, M.D. Click here to view the Report    Click here to view the abstract

Review 
Acute myocardial infarction: failed thrombolysis
  de Belder MA
  Heart 2001;85 104-112 
  Click here to view the full article
Currently, most patients are treated with either thrombolytic agents or primary angioplasty. Thrombolytic agents on their own do well but not well enough. The re-establishment of coronary flow helps many patients, but for others these agents either do not restore flow, or do it too slowly. Patients with the diagnosis of "failed thrombolysis" fare badly, even if it is diagnosed early (one hour after onset of treatment). A number of methods are available to identify these patients, and although they are imprecise, a convenient and easy-to-use method is to examine the ST segments on the standard 12 lead ECG.

Multimodality reperfusion therapy for acute myocardial infarction
  Cannon CP
  Am Heart J 2000;140:707-16
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0011054614 
Bolus fibrinolytic agents are being evaluated for use in combination with other interventions to open occluded coronary arteries, including acute percutaneous coronary intervention, the glycoprotein IIb/IIIa platelet inhibitors, or both. The goal of this "multimodality" approach to AMI management is to minimize time to reperfusion and maximize the percentage of patients who achieve complete arterial patency and myocardial perfusion without bleeding complications.

The PRAGUE study - Multicentre randomized trial comparing transport to primary angioplasty vs immediate thrombolysis vs combined strategy for patients with acute myocardial infarction presenting to a community hospital without a catheterization laboratory
  Widimsky P et al.
  Eur Heart J 2000;21:823-31
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010781354
Transferring patients from community hospitals to a tertiary angioplasty centre in the acute phase of myocardial infarction is feasible and safe. This strategy is associated with a significant reduction in the incidence of reinfarction and the combined clinical end-point of death/reinfarction/stroke at 30 days when compared to standard thrombolytic therapy at the community hospital.

Early angiography versus conservative treatment in patients with non-ST elevation acute myocardial infarction: MITI Investigators. Myocardial Infarction Triage and Intervention
  Scull GS et al.
  J Am Coll Cardiol 2000;35:895-902
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010732885
  Click here for additional comments
An early invasive strategy was associated with a lower long-term mortality in non-Q wave MI patients

Outcome of patients with acute myocardial infarction who are ineligible for primary angioplasty trials
  Dauerman HL et al.
  Catheter Cardiovasc Interv 2000;49:237-43
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010700048
Primary angioplasty trials continue to exclude nearly 50% of acute infarction patients and reported mortality rates of primary angioplasty trials are likely to be significantly lower than the unselected in-hospital mortality rates

Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction
  Cannon CP et al.
  JAMA 2000;283:2941-7
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010865271
In this study , the relationship between increased mortality and delay in door-to-balloon time longer than 2 hours (present in nearly 50% of the cohort) suggests that physicians and health care systems should work to minimize door-to- balloon times and that door-to-balloon time should be considered when choosing a reperfusion strategy. Door-to-balloon time also appears to be a valid quality-of-care indicator.

Clinical and angiographic outcomes in patients with previous coronary artery bypass graft surgery treated with primary balloon angioplasty for acute myocardial infarction. Second Primary Angioplasty in Myocardial Infarction Trial (PAMI-2) Investigators
  Stone GW et al.
  J Am Coll Cardiol 2000;35:605-11
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010716461
Reperfusion success of a primary PTCA strategy in patients with previous CABG, although favorable with respect to historic control studies, is reduced as compared with that in patients without previous CABG. New approaches are required to treat patients with previous CABG and AMI, especially when the infarct- related vessel is a diseased saphenous vein graft

HEAP randomized trial. High dose heparin as pretreatment for primary angioplasty in acute myocardial infarction: the Heparin in Early Patency 
  Liem A et al.
  J Am Coll Cardiol 2000;35:600-4
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010716460
There is no benefit of high dose bolus heparin on early patency compared with no or low dose heparin.

Predictors of death and reinfarction at 30 days after primary angioplasty: the GUSTO IIb and RAPPORT trials
  Brener SJ et al.
  Am Heart J 2000;139:476-81
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010689262
Death and reinfarction after primary angioplasty are predominantly predicted by age, hemodynamic instability, and the attainment of TIMI 3 flow in the infarct artery.

A comparison of systematic stenting and conventional balloon angioplasty during primary percutaneous transluminal coronary angioplasty for acute myocardial infarction. STENTIM-2 Investigators
  Maillard L et al.
  J Am Coll Cardiol 2000;35:1729-36
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010841218
In the setting of primary angioplasty for AMI, as compared with a strategy of conventional balloon angioplasty, systematic stenting using the Wiktor stent results in lower rates of angiographic restenosis.

STOPAMI - Coronary stenting plus platelet glycoprotein IIb/IIIa blockade compared with tissue plasminogen activator in acute myocardial infarction. STOPAMI Investigators
  Schomig A et al.
  N Engl J Med 2000;343:385-91
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010933737
In patients with acute myocardial infarction, coronary stenting plus abciximab leads to a greater degree of myocardial salvage and a better clinical outcome than does fibrinolysis with a tissue plasminogen activator.

Effect of glycoprotein IIb/IIIa receptor blockade with abciximab on clinical and angiographic restenosis rate after the placement of coronary stents following acute myocardial infarction
  Neumann FJ et al.
  J Am Coll Cardiol 2000;35:915-21
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010732888
In patients undergoing stenting following AMI, abciximab exerted beneficial effects by substantially reducing the 30-day rate of major adverse cardiac events. During one-year follow-up, there was no additional benefit from a reduction in TLR nor did abciximab reduce angiographic restenosis.

Increased platelet aggregability in response to shear stress in acute myocardial infarction and its inhibition by combined therapy with aspirin and cilostazol after coronary intervention
  Tanigawa T et al.
  Am J Cardiol 2000;85:1054-9
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010781751
Patients with AMI have increased platelet aggregability in response to high shear stress. Combined antiplatelet therapy with ASA + cilostazol appears to be as effective as therapy with ASA + ticlopidine for reducing shear stress-induced platelet aggregation in patients with AMI who are undergoing primary angioplasty.

Review of immediate angioplasty after fibrinolytic therapy for acute myocardial infarction
Insights from the RESCUE I, RESCUE II, and other contemporary clinical experiences
  Ellis SG et al.
  Am Heart J 2000;139:1046-53
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010827386
Probable benefit of rescue PTCA in several distinct scenarios. The pivotal mid-1980s studies suggesting no benefit or harm for PTCA after fibrinolytic therapy may no longer be relevant. Data from contemporary randomized studies of stents and glycoprotein IIb/IIIa inhibitors suggest that PCI as performed today may yield better results than those reviewed. 

Intracoronary adenosine administered during percutaneous intervention in acute myocardial infarction and reduction in the incidence of "no reflow" phenomenon
  Assali AR et al.
  Catheter Cardiovasc Interv 2000;51:27-31; discussion 32
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010973014
Procedural outcomes of 79 patients who underwent PCI for AMI. Twenty-eight patients did not receive adenosine, and 51 received intracoronary adenosine boluses (24-48 microg before and after each balloon inflation). Eight patients who were not given adenosine experienced no reflow (28.6%) and higher rates of in-hospital death, while only three of 51 patients (5.9%; P = 0.014) in the adenosine group experienced no reflow. No untoward complications were noted during adenosine infusion. In conclusion, Intracoronary adenosine bolus administration during PCI for AMI is easy and safe and may significantly lessen the incidence of no reflow, which may improve the outcome of this procedure.

Coronary flow velocity immediately after primary coronary stenting as a predictor of ventricular wall motion recovery in acute myocardial infarction
  Wakatsuki T et al.
  J Am Coll Cardiol 2000;35:1835-41
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010841232
The coronary flow velocity pattern measured immediately after successful primary stenting is predictive of the recovery of regional and global LV function in patients with AMI.

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DeGeare VS, et al.
Am J Cardiol 2000;86:30-4.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10867088 
 
Comparison of primary angioplasty with conservative therapy in patients with acute myocardial infarction and contraindications for thrombolytic therapy. Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Study Group
Zahn R, et al.
Catheter Cardiovasc Interv 1999;46:127-33.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10348528 
 
Differences in patients with acute myocardial infarction treated with primary angioplasty or thrombolytic therapy. Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Study Group
Zahn R, et al.
Clin Cardiol 1999;22:191-9.
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Primary percutaneous transluminal coronary angioplasty for acute myocardial infarction in patients not included in randomized studies. Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Study Group
Zahn R, et al.
Am J Cardiol 1999;83:1314-9.
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Primary angioplasty for the treatment of acute myocardial infarction: experience at two community hospitals without cardiac surgery
Wharton TP, Jr., et al.
J Am Coll Cardiol 1999;33:1257-65.
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Abciximab in the treatment of acute myocardial infarction eligible for primary percutaneous transluminal coronary angioplasty. Results of the Glycoprotein Receptor Antagonist Patency Evaluation (GRAPE) pilot study
van den Merkhof LF, et al.
J Am Coll Cardiol 1999;33:1528-32.
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A randomized comparison of intra-aortic balloon pumping after primary coronary angioplasty in high risk patients with acute myocardial infarction
van 't Hof AW, et al.
Eur Heart J 1999;20:659-65.
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A randomized evaluation of early revascularization to treat shock complicating acute myocardial infarction. The (Swiss) Multicenter Trial of Angioplasty for Shock-(S)MASH
Urban P, et al.
Eur Heart J 1999;20:1030-8.
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Clinical and angiographic follow-Up after primary stenting in acute myocardial infarction: the Primary Angioplasty in Myocardial Infarction (PAMI) stent pilot trial
Stone GW, et al.
Circulation 1999;99:1548-54.
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Glycoprotein IIb/IIIa Receptor Inhibitors During Primary Angioplasty for Acute Myocardial Infarction
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Curr Interv Cardiol Rep 1999;1:359-367.
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Grines CL, et al.
N Engl J Med 1999;341:1949-56.
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Clinical experience with primary percutaneous transluminal coronary angioplasty compared with alteplase (recombinant tissue-type plasminogen activator) in patients with acute myocardial infarction: a report from the Second National Registry of Myocardial Infarction (NRMI- 2)
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Circulation 1998;97:2502-5.
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Stenting in Acute Myocardial Infarction: Observational Studies and Randomized Trials N 1998
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J Invasive Cardiol 1998;10 Suppl A:16A-26A.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=10762855 
 
Stenting and IIb/IIIa Receptor Blockade in Acute Myocardial Infarction: An Introduction to the CADILLAC Trial
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J Invasive Cardiol 1998;10 Suppl B:36B-47B.
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Prospective, multicenter study of the safety and feasibility of primary stenting in acute myocardial infarction: in-hospital and 30-day results of the PAMI stent pilot trial. Primary Angioplasty in Myocardial Infarction Stent Pilot Trial Investigators
Stone GW, et al.
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Rescue angioplasty after failed thrombolysis: technical and clinical outcomes in a large thrombolysis trial. GUSTO-1 Angiographic Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries
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In-hospital and late results of coronary stents versus conventional balloon angioplasty in acute myocardial infarction (GRAMI trial). Gianturco-Roubin in Acute Myocardial Infarction
Rodriguez A, et al.
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Cathet Cardiovasc Diagn 1998;43:327-30.
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Comparison of primary coronary stenting to primary balloon angioplasty with stent bailout for the treatment of patients with acute myocardial infarction
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Am Heart J 1998;135:714-8.
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Heterogeneity of prognosis in patient subsets treated by primary coronary angioplasty during acute myocardial infarction
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http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9604958 
 
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Incidence, consequences, and risk factors of early reocclusion after primary and/or rescue percutaneous transluminal coronary angioplasty for acute myocardial infarction
Garot P, et al.
Am J Cardiol 1998;82:554-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9732878 
 
Dangers of delay of initiation of either thrombolysis or primary angioplasty in acute myocardial infarction with increasing use of primary angioplasty
Doorey A, et al.
Am J Cardiol 1998;81:1173-7.
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Directional coronary atherectomy in acute myocardial infarction
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Cardiology 1998;90:63-6.
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Intercenter variability in outcome for patients treated with direct coronary angioplasty during acute myocardial infarction
Christian TF, et al.
Am Heart J 1998;135:310-7.
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Delayed percutaneous transluminal coronary angioplasty after acute myocardial infarction
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Int J Cardiol 1998;63:199-204.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9578344 
 
Randomized, placebo-controlled trial of platelet glycoprotein IIb/IIIa blockade with primary angioplasty for acute myocardial infarction. ReoPro and Primary PTCA Organization and Randomized Trial (RAPPORT) Investigators
Brener SJ, et al.
Circulation 1998;98:734-41.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9727542 
 
Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators
Boden WE, et al.
N Engl J Med 1998;338:1785-92.
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Abciximab in primary coronary angioplasty for acute myocardial infarction improves short- and medium-term outcomes
Azar RR, et al.
J Am Coll Cardiol 1998;32:1996-2002.
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A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction: results from the Florence Randomized Elective Stenting in Acute Coronary Occlusions (FRESCO) trial
Antoniucci D, et al.
J Am Coll Cardiol 1998;31:1234-9.
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Tissue-type plasminogen activator therapy versus primary coronary angioplasty: impact on myocardial tissue perfusion and regional function 1 month after uncomplicated myocardial infarction
Agati L, et al.
J Am Coll Cardiol 1998;31:338-43.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9462577 
 
Randomized comparison of primary coronary angioplasty with thrombolytic therapy in low risk patients with acute myocardial infarction
Zijlstra F, et al.
J Am Coll Cardiol 1997;29:908-12.
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Primary angioplasty versus thrombolysis in the treatment of acute myocardial infarction. ALKK Study Group
Zahn R, et al.
Am J Cardiol 1997;79:264-9.
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Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review
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Jama 1997;278:2093-8.
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Topol EJ.
Cleve Clin J Med 1997;64:9-12.
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Stone GW, et al.
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Stone GW, et al.
N Engl J Med 1997;337:1168-9; discussion 1170.
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Primary Stenting in Acute Myocardial Infarction: Design and Interim Results of the PAMI Stent Pilot Trial
Stone GW, et al.
J Invasive Cardiol 1997;9:24B-30B.
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Analysis of the relative costs and effectiveness of primary angioplasty versus tissue-type plasminogen activator: the Primary Angioplasty in Myocardial Infarction (PAMI) trial. The PAMI Trial Investigators
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Coronary stent placement in patients with acute myocardial infarction: comparison of clinical and angiographic outcome after randomization to antiplatelet or anticoagulant therapy
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N Engl J Med 1997;336:1103; discussion 1104.
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Predictors of success and major complications for primary percutaneous transluminal coronary angioplasty in acute myocardial infarction. An analysis of the 1990 to 1994 Society for Cardiac Angiography and Interventions registries
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