The STREAM study (Strategic Reperfusion Early After Myocardial Infarction) that included 1891 patients gave support to the fibrinolytic infusion strategy in the ambulance in patients treated within 3 hours of stroke and who cannot receive primary angioplasty within the hour versus primary angioplasty. The primary end point was a composite of death from any cause,...

The phenomenon of reperfusion injury is responsible for 50 % of the final infarct size. Several pharmacological and non-pharmacological agents administered before or during the ischemic period could significantly reduce infarct size in experimental studies in humans, but the results were inconsistent. This study tested the hypothesis that intravenous nitroprusside infusion immediately before the opening...

Ischemic postconditioning obtained through reversible ischemia and reproduced during reperfusion after a prolonged ischemic injury has shown comparable effects to ischemic preconditioning in preclinical phase. A study in humans showed a reduction in serum markers of AMI thanks to Ischemic postconditioning in the context of primary angioplasty. Different MRI studies showed conflicting results regarding the...

Basics: Recent meta-analysis showed benefits of intracoronary abciximab administration compared with intravenous (A-EV). Although the AIDA study showed no such benefit when analyzing the combined endpoints of death, reinfarction and congestive heart failure, it did show a decrease of CHF in isolation over the group receiving intracoronary abciximab. This time, the study authors of AIDA...

The trial enrolled 200 patients post AMI treated with successful PCI, with LVEF ≤45% randomized to placebo, to receive early (before 7 days) or late (after 7 days) stem cells infusion. Primary end point was LVEF at 4 months. At follow up, stem cells infusion, both early and late, did not improve LVEF, compared to...

The HORIZONS AMI trial showed the usefulness of bivalirudin in reducing mortality and bleeding compared with the use of heparin plus glycoprotein IIBIIIA. However, some questions remained unanswered: What is the utility of starting the infusion during the ambulance journey? Is it possible to reduce the risk of acute thrombosis by extending bivalirudin infusion or...

The aim of this study was to evaluate the clinical impact resistance thienopyridines through genetic analysis of CYP2C19 receptor. The primary endpoint was  a combination of mortality, myocardial infarction, stent thrombosis in the resistance group (few responders) versus non-resistant (responders) to the thienopyridines. 1445 patients were included of which 22% were considered few responders. There...

The clinical benefit of thrombus aspiration during angioplasty in patients with ST-segment elevation myocardial infarction is uncertain. The purpose of this work was to test if thrombus aspiration reduces mortality. This was a multicenter, prospective, randomized and controlled study that included patients with ST-segment elevation myocardial infarction within 24 hours of evolution. The catheters used...