Reperfusion Therapy for Acute Myocardial Infarction (Fundamental and Clinical Cardiology)

418 Pages·2008·4.79 MB·English

by  Eric R. Bates

Cardiology AR
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about the book…
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Reperfusion Therapy for Acute Myocardial Infarction provides a comprehensive te
review of reperfusion therapy for ST-segment elevation myocardial infarction e
r
(STEMI). Professor Eric R. Bates and his international team of contributors will f
examine current and future reperfusion therapies for STEMI, in conjunction with the Mu
latest clinical trials and guidelines, to bring you the most in-depth and thorough s
review of management strategies for these patients. This source addresses key yi
developments that will reduce logistical barriers, improve times-to-treatment, and oo
ensure that appropriate medications are administered in patient care. cn
Showing the benefi ts of reperfusion therapy, this source: a
T
• examines fi brinolytic agents that can be used alone, or in combination with r
other care regimens, to improve the benefi ts of reperfusion therapy and reduce dh
the risks of treatment ie
a
• summarizes the use of percutaneous coronary intervention (PCI) across the r
spectrum of reperfusion therapy la

• helps specialists identify barriers to the early treatment of patients in various Ip
n
practice environments
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• reviews the clinical relevance and implications of recent clinical trials, and the f
a
integration of these fi ndings into the current practice of acute reperfusion f
therapy. ro
c
r
t
about the editor... i
o
ERIC R. BATES is Professor of Internal Medicine at the University of Michigan.
n
Dr. Bates received his M.D. from the University of Michigan Medical School, Ann
Arbor, and trained in internal medicine and cardiology at the University of Michigan Reperfusion Therapy
Hospitals. His major clinical interests include acute myocardial infarction, acute
coronary syndromes, and coronary artery disease. His research efforts have focused
on fi brinolytic and catheter-based reperfusion therapy for acute myocardial infarction
and cardiogenic shock, antiplatelet and anticoagulant therapy for coronary throm- for Acute
bosis, and coronary artery revascularization. Dr. Bates has served on the steering
committees for several important international multicenter randomized clinical trials.
He serves on the editorial boards of the American Journal of Cardiology, the European
Journal of Cardiology, the Journal of the American College of Cardiology, the American Myocardial
Heart Journal, Catheterization and Cardiovascular Interventions, and Cardiology News.
Dr. Bates is a member of the ACC/AHA writing committee to update the 1999
guidelines for acute myocardial infarction. He is also a member of the American B
ATES
Board of Internal Medicine Interventional Cardiology Test Committee. Infarction
Printed in the United States of America
DK585X
E R. B
E RIC ATES
DITED BY
Reperfusion Therapy
for Acute
Myocardial
Infarction
FUNDAMENTAL AND CLINICAL CARDIOLOGY
Editor-in-Chief
Samuel Z. Goldhaber, M.D.
HarvardMedical SchoolandBrigham
and Women’sHospital Boston,
Massachusetts, U.S.A.
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2. Cardiotonic Drugs: A Clinical Review, Second Edition, Revised
and Expanded, edited by Carl V. Leier
3. Complications of Coronary Angioplasty, edited by Alexander J. R. Black,
H. Vernon Anderson, and Stephen G. Ellis
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and Henry S. Miller, Jr.
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Function, edited by Robert Boyer Francis, Jr.
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10. Thrombolysis and Adjunctive Therapy for Acute Myocardial Infarction,
edited by Eric R. Bates
11. Stunned Myocardium: Properties, Mechanisms, and Clinical
Manifestations, edited by Robert A. Kloner and Karin Przyklenk
12. PreventionofVenousThromboembolism,editedbySamuelZ.Goldhaber
13. Silent Myocardial Ischemia and Infarction: Third Edition, Peter F. Cohn
14. Congestive Cardiac Failure: Pathophysiology and Treatment, edited by
David B. Barnett, Hubert Pouleur and Gary S. Francis
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Judith K. Gwathmey, G. Maurice Briggs, and Paul D. Allen
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and Adjunctive Therapy, edited by Burton E. Sobel and Desire Collen
17. Cardiovascular Disease in the Elderly Patient, edited by Donald
D. Tresch and Wilbert S. Aronow
18. Systemic Cardiac Embolism, edited by Michael D. Ezekowitz
19. Low-Molecular-Weight Heparins in Prophylaxis and Therapy of
Thromboembolic Diseases, edited by Henri Bounameaux
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M. G. Duran
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and C. Venkata S. Ram
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Vivek K. Mehan
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25. Interventional Cardiology: New Techniques and Strategies for Diagnosis
and Treatment, edited by Christopher J. White and Stephen Ramee
26. Molecular Genetics and Gene Therapy of Cardiovascular Diseases,
edited by Stephen C. Mockrin
27. The Pericardium: A Comprehensive Textbook, David H. Spodick
28. Coronary Restenosis: From Genetics to Therapeutics, edited by
Giora Z. Feuerstein
29. The Endothelium in Clinical Practice: Source and Target of Novel
Therapies, edited by Gabor M. Rubanyi and Victor J. Dzau
30. MolecularBiologyofCardiovascularDisease,editedbyAndrewR.Marks
and Mark B. Taubman
31. Practical Critical Care in Cardiology, edited by Zab Mohsenifar and
P. K. Shah
32. Intravascular Ultrasound Imaging in Coronary Artery Disease, edited by
Robert J. Siegel
33. Saphenous Vein Bypass Graft Disease, edited by Eric R. Bates
and David R. Holmes, Jr.
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and Expanded, edited by Roy J. Shephard and Henry S. Miller, Jr
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edited by Jeffrey S. Borer and John C. Somberg
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and Expanded, edited by Donald D. Tresch and Wilbert S. Aronow
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Chimowitz
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Patricia McCall Comoss
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and Andreas Greinacher
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Approaches, edited by Peter M. Spooner and Michael R. Rosen
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Concepts, J. Willis Hurst
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E. Warkentin and Andreas Greinacher
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and Paul M. Ridker
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Edition,RevisedandExpanded,editedbyArthurA.SasaharaandJoseph
Loscalzo
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Warkentin and Andreas Greinacher
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Greenberg
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and William A. Baumgartner
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and Peter P. Toth
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and Abraham Thomas
59. Risk Factors in Coronary Artery Disease, edited by P. K. Shah
60. Handbook of Cardiovascular Magnetic Resonance Imaging, edited by
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61. Acute Aortic Disease, edited by John A. Elefteriades
62. Heparin-Induced Thrombocytopenia, Fourth Edition, edited by
Theodore E. Warkentin and Andreas Greinacher
63. Cardiovascular Disease in the Elderly, Fourth Edition, edited by
Wilbert S. Aronow, Jerome Fleg, and Michael W. Rich
64. Reperfusion Therapy for Acute Myocardial Infarction, edited by
Eric R. Bates
Reperfusion Therapy
for Acute
Myocardial
Infarction
Edited by
E r. B
ric atEs
University of Michigan Medical Center
Ann Arbor, Michigan, USA
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Reperfusiontherapyforacutemyocardialinfarction/editedbyEricR.Bates.
p.;cm.— (Fundamentalandclinicalcardiology;v.64)
Includesbibliographicalreferencesandindex.
ISBN-13:978-0-8493-4358-2(hardcover:alk.paper)
ISBN-10:0-8493-4358-5(hardcover:alk.paper)
1. Myocardialinfarction—Treatment.2. Myocardialreperfusion.
I. Bates,EricR. II.Series.
[DNLM:1. MyocardialInfarction—therapy.2. Reperfusion—methods.
W1FU538TDv.642008/WG300R42552008]
RC685.I6R452008
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Series Introduction
InformaHealthcarehasdevelopedvariousseriesofbeautifullyproducedbooksin
different branches of medicine. These series have facilitated the integration of
rapidly advancing information for both the clinical specialist and the researcher,
especially in the area of cardiovascular medicine.
Eric R. Bates, MD, has compiled and edited a new masterpiece on the man-
agementofthe developedworld’s numberonekiller:acutemyocardialinfarction.
The revolution in treatment began three decades ago with emergency reperfusion
therapy.Restoringbloodflowtothethrombosedcoronaryarterybecamestandard
ofcare,ratherthanamaverickprocedurestigmatizedbylittleevidencetoproveits
success. In fact, reperfusion therapy has saved millions of lives and has changed
thelandscapeofcardiology.Immediatedeathfromheartattackhasbecomemuch
less commonthan chronicillness fromadvancedheartfailure amongsurvivors of
myocardial infarction afflicted with ‘‘ischemic cardiomyopathy.’’
Dr. Bates, an interventional cardiologist with legendary technical skills, has
advanced the field with his academic contributions in fibrinolytic reperfusion,
mechanical reperfusion, and adjunctive therapy for reperfusion. In this gem of a
textbook, he has summoned the world’s All Stars to provide updated accounts in
theirareasofreperfusionexpertise.TheauthorsconstituteaWho’sWhointhefield
ofmyocardialinfarctiontreatment.EugeneBraunwald,MD,writesthefirstchapter
on historical milestones while Elliott M. Antman, MD, concludes with future
perspectives. Dr. Bates includes an appendix with the most recent reperfusion
guidelines issued by the world’s three leading cardiology organizations.
My goal as an editor-in-chief of the Fundamental and Clinical Cardiology
Seriesistoassemblethetalentsofworld-renownedauthoritiestodiscussvirtually
every area of cardiovascular medicine. We have achieved this objective with
ReperfusionTherapyforAcuteMyocardialInfarction.Futurecontributionstothisseries
will include books on molecular biology, interventional cardiology, and clinical
management of such problems as chronic coronary artery disease, venous throm-
boembolism, peripheral vascular disease, and cardiac arrhythmias.
SamuelZ.Goldhaber,MD
Boston,Massachusetts,U.S.A.
iii

Preface
Reperfusion therapy for ST-segment elevation myocardial infarction (STEMI) has
been an important clinical focus for 25 years. Impressive reductions in morbidity
and mortality rates have been achieved in STEMI, but with a growing and aging
population, STEMI remains a major public health problem. Moreover, many eli-
gible patients are not receiving recommended therapies.
Enormous strides have been made in understanding the pathophysiology of
atherosclerosis and plaque rupture, the usual inciting factor in STEMI, and new
interventionshavebeendevelopedtotreatthrombosisandinflammation.Numerous
clinical trials and registries have clarified the epidemiology of STEMI. Subgroup
analyseshaveresultedintheabilitytoaccuratelypredictindividualpatient risk.
Theachievementofsuccessfulmyocardialreperfusionhasevolvedfrominfarct
arterypatencytoinfarctarteryflowtomicrovascularreperfusion.Theadministration
of fibrinolytic therapy has become easier as intravenous therapy replaced intra-
coronaryadministration,andbolustherapyreplacedinfusiontherapy,butaceilingof
reperfusion success rates of approximately 75% has limited further advances. Cathe-
ter-basedreperfusionachieveshigherinfarctarterypatencyrates,butaccesshasbeen
limited to a minority of patients and treatment delays may diminish some of its
advantage. The combination of pharmacological therapy and catheter-based therapy
as a rescue or facilitated percutaneous coronary intervention (PCI) strategy has been
studied with the hope that better outcomes can be achieved. Others are performing
PCIathospitalswithouton-sitecardiacsurgeryorestablishingrapidtransferpolicies
inanattempt todecrease door-to-balloontimes.
The results of reperfusion therapy with fibrinolytics and PCI have been
improved with adjunctive antiplatelet and antithrombotic agents. New pharma-
cological and mechanical interventions are under investigation to reduce the
impactofreperfusioninjuryandthrombusembolizationonmyocardialinfarctsize.
Major limitations in delivering care to patients with STEMI are systems
problems in organizing pre-hospital and emergency department diagnosis and
treatment plans. Quality improvement initiatives and critical pathway develop-
ment can reduce logistical barriers, improve times-to-treatment, and ensure that
appropriate medications are administered.
Complications associated with STEMI and its treatment remain challenging.
However, new interventions and the possibility of myocyte regeneration offer the
opportunity of even better therapies in the future.
Thegoalofthisbookistoreviewthepast,present,andfutureofreperfusion
therapy for STEMI. An internationally known group of leading authorities in this
fieldhavecontributedtheirexpertisetothiseffort.Wehopethatthisbookwillbea
usefulresourceforallofthehealthprofessionalswhocareforpatientswithSTEMI.
Eric R. Bates
v