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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\n      \u003Ch2\u003ESummary\u003C\/h2\u003E\n      \u003Cp id=\u0022p-1\u0022\u003ERapid myocardial reperfusion is the primary goal in patients with ST-segment elevation myocardial infarction, and the extent to which early reperfusion is achieved is the main factor in determining the extent of the early and long-term clinical benefit of treatment. This article discusses several approaches to improving outcomes in these patients.\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emyocardial infarction\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n      \u003Cp id=\u0022p-2\u0022\u003ERapid myocardial reperfusion is the primary goal in patients with ST-segment elevation myocardial infarction (STEMI), and the extent to which early reperfusion is achieved is the main factor in determining the extent of the early and long-term clinical benefit of treatment. Rajesh M. Dave, MD, Ortenzio Heart Center, Harrisburg, Pennsylvania, USA, reviewed several approaches to improving outcomes in these patients.\u003C\/p\u003E\n      \u003Cp id=\u0022p-3\u0022\u003ETwo methods for achieving reperfusion include percutaneous coronary intervention (PCI) and fibrinolysis. The success of PCI is frequently assessed in terms of ST-segment elevation resolution or return to normal angiographic TIMI (TIMI 3) flow. Dr. Dave suggested that these two measures may not go far enough. He cited myocardial blush grade (MBG), an angiographic measure of myocardial perfusion, which has been shown to be independently associated with mortality [Svilaas T et al. \u003Cem\u003ENew Engl J Med\u003C\/em\u003E 2008; Kampinga MA et al. \u003Cem\u003ECirc Cardiovasc Interv\u003C\/em\u003E 2010], and suggested that MBG should be documented in addition to TIMI flow as a measure of PCI success.\u003C\/p\u003E\n      \u003Cp id=\u0022p-4\u0022\u003ECatheter-based thrombectomy is a newer modality that may improve reperfusion and outcomes in STEMI patients who are treated with urgent PCI. In a pooled analysis of data from more than 2500 patients in 11 clinical trials, Burzotta and colleagues showed that thrombectomy (in particular, manual thrombectomy) significantly improves the clinical outcome in patients with STEMI who are undergoing mechanical reperfusion and that its effect may be enhanced with the addition of potent antiplatelet therapy (eg, GP IIb\/IIIa inhibitors) [Burzotta F et al \u003Cem\u003EEur Heart J\u003C\/em\u003E 2009].\u003C\/p\u003E\n      \u003Cp id=\u0022p-5\u0022\u003EDr. Dave discussed the results of CRYSTAL AMI, a single-center, prospective, randomized, proof-of-concept study of intravenous (IV) abciximab versus intracoronary (IC) abciximab in patients with acute myocardial infarction who were undergoing PCI within 6 hours of symptom onset. All patients received heparin and a 600-mg clopidogrel load. The use of thrombectomy devices was permitted. MBG, TIMI flow, and ST resolution were evaluated at the end of the procedure, and left ventricular function was evaluated by echocardiography at discharge. Echocardiography was repeated at 30 days, at which time patients also underwent a resting Sestamibi scan. In the IC group 92% of patients achieved the primary endpoint of postprocedure MBG \u0026gt;2 versus 86% of patients who received IV therapy (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). TIMI flow was also higher among patients who received IC therapy (96%) versus those who received IV therapy (82%). There were no readmissions or deaths in the IC arm versus 2 readmissions and 1 death among patients who received IV therapy. There were no major bleeds in either group.\u003C\/p\u003E\n      \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\n         \u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\n            \n               \u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/6\/13.1\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022MGB Score.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1244047864\u0022 data-figure-caption=\u0022MGB Score.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/6\/13.1\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\n            \n            \n         \u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/6\/13.1\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/6\/13.1\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12487\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\n         \u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\n            \u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EMGB Score.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from R. Dave, MD.\u003C\/q\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\n      \u003Cp id=\u0022p-7\u0022\u003E\u201cImproving myocardial preservation in patients presenting with STEMI has profound economic impact through reduced cost of care, improved quality of life, and less need for ICD implantation.\u201d This approach is being further evaluated in the INFUSE-AMI study, a randomized, multicenter, single-blind evaluation of IC abciximab infusion and aspiration thrombectomy in patients who are undergoing PCI for anterior STEMI that is currently recruiting [Gibson CM et al. \u003Cem\u003EAm Heart J\u003C\/em\u003E 2011; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00976521\u0026amp;atom=%2Fspmdc%2F11%2F6%2F13.1.atom\u0022\u003ENCT00976521\u003C\/a\u003E].\u003C\/p\u003E\n   \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/6\/13.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn0e2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn0e2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}