caress in acute myocardial infarction

Conditions: Myocardial Infarction

Summary: the aim of this study conducted in patients with high risk st-segment elevation ami admitted to hospitals with no ptca facilities is to compare the effects on clinical outcome and cost-effectiveness of two reperfusion strategies: * fibrinolytic therapy with abciximab and half-dose reteplase, with rescue ptca in case of lack of reperfusion * elective referral for "facilitated" ptca after early administration of abciximab and half dose of reteplase

all patients with st-segment elevation ami admitted within 12 hours from symptoms onset will be screened to enter in this study. data of patients with st-segment elevation ami within 12 hours from symptoms onset who do not meet the inclusion criteria or do not sign the informed consent form are entered into a dedicated registry.

Eligibility criteria:
inclusion criteria: - ecg with st-elevation (≥ 1mm in at least 2 ecg limb leads or ≥ 2 mm in 2 contiguous precordial leads) ami within \<12 hours from symptoms onset fulfilling 1 or more of the following criteria of "high risk": 1. summation of st-segment elevation or depression ≥ 15 mm in all 12 electrocardiographic leads or new onset complete left bundle branch block; 2. previous myocardial infarction (q- and non q-wave); 3. killip class 2 or 3; 4. lv ejection fraction at transthoracic ultrasound \< 40%. exclusion criteria: 1. inability to provide informed consent; 2. age \> 75 years 3. cabg or pci procedure in past history involving the infarct-related artery; 4. participation in another study with any investigational drug or device within the previous 30 days; 5. concomitant non-cardiac disease likely to limit long-term prognosis (e.g. cancer); 6. cardiogenic shock (hypotension with systolic blood pressure (sbp) \ 100 beats / min, not due to hypovolemia and requiring inotropic support or balloon counterpulsation); 7. need for concomitant major surgery (e.g. valve surgery or resection of aortic or left ventricular aneurysm, carotid endarterectomy, abdominal aortic aneurysm surgery, congenital heart disease etc); 8. severe hepatic disease; 9. patients with acute or chronic renal impairment (serum creatinine \> 2.0 mg % or 200 mg/l or creatinine clearance \< 30 ml/min); 10. transmural mi in different location within the previous week; 11. previous administration of thrombolytics within 7 days; 12. intolerance or contraindications to asa or clopidogrel; 13. known leucopenia, defined as a leukocyte count of \< 3.500 white blood cells (wbc)/ml 14. known neutropenia, defined as \< 1000 neutrophils / ml; 15. known thrombocytopenia (\< 100.000 platelets / ml ); 16. documented active peptic ulcer or upper gastrointestinal bleeding within the previous 6 months; 17. previous hemorrhagic stroke; 18. previous ischemic cerebrovascular event within 3 months; 19. intracranial neoplasm; 20. recent major surgery at risk of bleeding; 21. episodes of uncontrolled hypertension (\> 180/110 mmhg despite treatment) in past 2 years; 22. administration of oral anticoagulants within the previous 7 days unless inr ≤ 1.2; 23. severe recent trauma; 24. known or possible pregnancy; 25. absence of suitable vascular access (diffuse peripheral arterial disease); 26. basal ecg changes which make identification of st-segment elevation impossible (i.e.: ventricular activation from artificial pacemaker, etc.).

Keywords: ami stent ptca abciximab reteplase combo therapy