Evaluation de la fibrinolyse par la streptokinase dans l’infarctus du myocarde avec sus décalage du segment sT admis aux urgences.
Mots-clés :
Syndrome coronaire aigu - Infarctus du myocarde - Thrombolyse thérapeutique - Streptokinase - Urgence.Résumé
Prérequis : La fibrinolyse lors de l’Infarctus du Myocarde avec sus décalage ST (IDM ST+) est réalisable dans les services d’urgence ce qui permet de réduire le délai 1er contact médical – reperfusion coronaire.But : 1) évaluer la fibrinolyse par la streptokinase (SK) dans les IDM ST+ admis aux urgences. 2) identifier les critères cliniques prédictifs de succès de thrombolyse.
méthodes: étude prospective (juillet 2008-mars 2012). Inclusion des IDM ST + thrombolysés par la SK. Le succès de fibrinolyse a été défini sur des critères cliniques et ECG. Etude multivariée des facteurs associés au succès de thrombolyse.
résultats : sur les 329 IDM ST+ vus pendant la période de l’étude, 224 (68%) ont été thrombolysés. Age moyen = 57 ± 11 ans (20 à 86 ans); sex–ratio = 6. Le délai moyen douleur thoracique – admission aux urgences était de 195 ± 177 min (15 min à 12 heures). Les 2/3 des patients avaient consulté durant les 3 premières heures. Le taux moyen de succès de fibrinolyse a été de 59% et a atteint 83% la 1ère heure, 66% la 2ème heure et 58,7% la 3ème heure. En analyse multivariée, les trois facteurs indépendants prédictifs d’un succès de fibrinolyse étaient un tabagisme actif, un traitement en cours par bêta bloquants et un délai douleur thoracique – arrivée aux urgences inférieur ou égal à 180 min. En revanche, le diabète était un facteur associé à l’échec de fibrinolyse. La fibrinolyse s’était compliquée de 2 hémorragies intracérébrales. Trois patients étaient décédés aux urgences.
Conclusion : deux tiers des IDM ST+ ont consulté 3 h après la survenue de la douleur thoracique. La fibrinolyse par la streptokinase a été efficace dans 59% des cas.
Téléchargements
Références
Management of acute myocardial infarction in patients presenting with persistent ST - segment elevation. The Task Force on the management of ST - segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 2008; 29:2909 - 45.
Prise en charge de l'infarctus du myocarde à la phase aiguë en dehors des services de cardiologie. Recommandations professionnelles. Conférence de consensus 23 novembre 2006. SAMU de France, Société Française de Médecine d'Urgence, Société Française de Cardiologie. Haute Autorité de Santé. www.has-sante.fr
Antman EM, Anbe DT, Armstrong PW et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of PatientsWith Acute Myocardial Infarction). J Am Coll Cardiol 2004;44:671-719.
Rogers WJ, Frederick PD, Stoehr E et al. Trends in presenting characteristics and hospital mortality among patients with ST elevation and non-ST elevation myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J 2008;156:1026 -34.
Sabatine MS, Cannon CP, Gibson CM et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med 2005;352:1179-89.
Antman EM, Morrow DA, McCabe CH et al. Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction. N Engl J Med 2006;354:1477-88.
Mghaieth F, Aloui H, Chabrak S et al. Pronostic hospitalier de l'infarctus du myocarde: comparaison de deux périodes à dix ans d'intervalle. Ann Cardiol Angeiol 2006;55:241-5.
Jemaa R, Kafsi MN, Kallel A et al. Distribution of cardiovascular risk factors in a Tunisian cohort of 6901 coronary patients. Arch Mal Coeur Vaiss 2004;97:20-24.
Added F, Dridi Z, Jemmali M et al. ”Smoker's Paradox” and reperfusion's strategy in acute myocardial infarction. Ann Cardiol Angeiol 2010;59:183-189.
Gibson CM. Time Is Myocardium and Time Is Outcomes. Circulation 2001;104:2632-34.
Ouldzein H, Aounallah-Skhiri H, Zouaoui W, Benromdhane H, Kafsi N, Mechmeche R. Management of acute myocardial infarction:the experience of a Tunisian hospital. Mali Med. 2008;23:47-50.
Bougatef S, Ben Romdhane H, Kafsi N et al. Delays in acute myocardial infarction treatment: results of a multicenter study in the district of Tunis (Tunisia)]. Tunis Med. 2005 May;83Suppl5:19-23.
Milestones in Acute Myocardial Infarction: Celebrating 10 Years of Insights from the National Registry of Myocardial Infarction. South San Francisco, Calif: Genentech Inc 2001:6-7.
Boersma E, Maas ACP, Deckers JW, Simoons ML. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet 1996;348:771-5.
Steg PG, Bonnefoy E, Chabaud S et al. Impact of Time to Treatment on Mortality After Prehospital Fibrinolysis or Primary Angioplasty. Data From the CAPTIM Randomized Clinical Trial of Angioplasty and Prehospital Thrombolysis In acute Myocardial infarction (CAPTIM) Investigators. Circulation 2003;108:2851- 6.
Bonnefoy E, Steg PG, Boutitie F et al. Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up. Eur Heart J 2009;30:1598-606.
Westerhout CM, Bonnefoy E, Welsh RC, Steg PG, Boutitie F, Armstrong PW. The influence of time from symptom onset and reperfusion strategy on 1-year survival in ST-elevation myocardial infarction: a pooled analysis of an early fibrinolytic strategy versus primary percutaneous coronary intervention from CAPTIM and WEST. Am Heart J 2011;161:283-90.
Boersma E. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients. Eur Heart J 2006;27:779-88.
Nallamothu BK, Fox KA, Kennelly BM et al. Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events. Heart 2007;93:1552-5.
Eagle1 KA, Nallamothu BK, Mehta RH et al. Global Registry of Acute Coronary Events (GRACE) Investigators. Trends in acute reperfusion therapy for ST-segment elevation myocardial infarction from 1999 to 2006: we are getting better but we have got a long way to go. Eur Heart J 2008;29:609-17.
The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329:673-82.
Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients Fibrinolytic Therapy Trialists' (FTT) Collaborative Group. Lancet 1994;343:311-22.
Gore JM, Granger CB, Simoons ML et al. Stroke after thrombolysis. Mortality and functional outcomes in GUSTO-I trial. Global Use of Strategies to Open Occluded Coronary Arteries. Circulation 1995;92:2811-18.
Van De Werf F, Adgey J, Ardissino D et al. Assessment of the safety and efficacy of a New Thrombolytic (ASSENT-2) investigators. Single-bolus tenecteplase compared with front loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial. Lancet 1999;354:716-22.
The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO III) Investigators. A comparison of reteplase with alteplase for acute myocardial infarction. N Engl J Med 1997;337:1118-23.
Sutton AG, Campbell PG, Price DJ et al. Failure of thrombolysis by streptokinase: detection with a simple electrocardiographic method. Heart 2000;84:149-56.
Doll R, Peto R. Mortality in relation to smoking: 20 years' observations on male British doctors. BMJ 1976;2:1525-36.
Peto R, Lopez AD, Boreham J et al. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet 1992;339:1268-78.
Kelly TL, Gilpin E, Ahnve S et al. Smoking status at the time of acute myocardial infarction and subsequent prognosis. Am Heart J 1985;110:535-41.
Andrikopoulos GK, Richter DJ, Dilaveris PE et al. In-hospital mortality of habitual cigarette smokers after acute myocardial infarction; the “smoker's paradox” in a countrywide study. Eur Heart J 2001;22:776-84.
Barbash GI, White HD, Modan M et al. Significance of smoking in patients receiving thrombolytic therapy for acute myocardial infarction. Experience gleaned from the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Circulation 1993;87:53-8.
Barbash GI, Reiner J, White HD et al. Evaluation of paradoxic beneficial effects of smoking in patients receiving thrombolytic therapy for acute myocardial infarction: mechanism of the “smoker's paradox “ from the GUSTO-I trial, with angiographic insights. Global Utilization of Streptokinase and Tissue- Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol 1995;26:1222-9.
Grines CL, Topol EJ, O'Neill WW et al. Effect of cigarette smoking on outcome after thrombolytic therapy for myocardial infarction. Circulation 1995;91:298-303.
Weisz G, Cox DA, Garcia E et al. Impact of smoking status on outcomes of primary coronary intervention for acute myocardial infarction-the smoker's paradox revisited. Am Heart J 2005;150:358-64.
Freemantle N, Cleland J, Young P, Mason J, Harrison J. Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ 1999; 318:1730-7.
Pfisterer M, Cox JL, Granger CB et al. Atenololol use and clinical outcomes after thrombolysis for acute myocardial infarction: the GUSTO I experience. Global Utilisation of Streptokinase and TPA (alteplase) for Occluded Coronary Arteries. J Am Coll Cardiol 1998;32:634-40.
Böhm M, Link A, Cai D et al. Beneficial association of ß-blocker therapy on recovery from severe acute heart failure treatment: Data from the Survival of Patients With Acute Heart Failure in Need of Intravenous Inotropic Support trial. Crit Care Med 2011;39:940-4.
Mak KH, Moliterno DJ, Granger CB et al. Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol 1997;30:171-9.
Schröder R, Wegscheider K, Schröder K, Dissmann R, Meyer- Sabellek W. Extent of early ST segment elevation resolution: a strong predictor of outcome in patients with acute myocardial infarction and a sensitive measure to compare thrombolytic regimens. A substudy of the International Joint Efficacy Comparison of Thrombolytics (INJECT) trial. J Am Coll Cardiol 1995;26:1657-64.
Wilson PW. Established risk factors and coronary artery disease: the Framingham Study. Am J Hypertens 1994;7:7S-12S.
Fresco C, Avanzini F, Bosi S et al. Prognostic value of a history of hypertension in 11,483 patients with acute myocardial infarction treated with thrombolysis. GISSI-2 Investigators. Gruppo Italiano per lo Studio della, Sopravvivena nell'Infarto Miocardico. J Hypertens 1996;14:743-50.
Souissi S, Chiboub S, Ghazali H et al. Facteurs de risque et pronostic de l'arrêt cardiaque compliquant les syndromes coronariens aigus avec sus-décalage ST admis aux urgences. Ann Fr Med Urgence 2010;0:S106.
Chan PS, Krumholz HM, Nichol G, Nallamothu BK. Delayed time to defibrillation after in-hospital cardiac arrest. N Engl J Med 2008;358:9-17.
Peberdy MA, Kaye W, Ornato JP et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 2003;58:297-308.
Meaney PA, Nadkarni VM, Kern KB, Indik JH, Halperin HR, Berg RA. Rhythms and outcomes of adult in-hospital cardiac arrest. Crit Care Med 2010;38:101-8.
Deakina CD, Nolanb JP, Soarc J et al. European Resuscitation Council Guidelines for Resuscitation 2010. Section 4. Adult advanced life support. Resuscitation 2010; 81:1305-52.
Hochman JS, Sleeper LA, Webb JG et al. Early revascularisation in acute myocardial infarction complicated by cardiogenic shock. SCHOCK investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. New Engl J Med 1999;341:625-34.
Hochman JS, Sleeper LA, White HD et al. One-year survival following early revascularisation for cardiogenic shock. JAMA 2001;285:190-2.
Goldstein JA, Lee DT, Pica MC, Dixon SR, O'Neill WW. Patterns of coronary compromise leading to bradyarrythmias and hypotension in inferior myocardial infarction. Coron Artery Dis 2005;16:265-74.
Meine TJ, Al-Khatib SM, Alexander JH et al. Incidence predictors and outcomes of high -degree atrioventricular block complicating acute myocardial infarction treated with thrombolytic therapy. Am Heart J 2005;149:670-4.
Tunstall-Pedoe H, Kuulasmaa K, Mähönen M et al. Contribution of trends in survival and coronary - event rates to changes in coronary heart disease mortality : 10 years results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet 1999;353:1547- 57.
