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F Zijlstra

Publications and source records attributed to F Zijlstra.

At least 73 records · Page 4Linked to original sources
PubMed1997

Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review.

OBJECTIVE: To provide a quantitative review of the treatment effects of primary coronary angioplasty vs intravenous thrombolysis for acute myocardial infarction. DATA SOURCES: Ten randomized trials were identified through computerized bibliographic search of MEDLINE from January 1985 through March 1996 and by queries of principal investigators. STUDY SELECTION: Single-center and multicenter randomized trials comparing primary angioplasty with intravenous thrombolytic therapy among 2606 patients were included. Four trials compared angioplasty with streptokinase, 3 compared angioplasty with a 3- to 4-hour infusion of tissue-type plasminogen activator, and 3 compared angioplasty with "accelerated" administration of tissue-type plasminogen activator over 90 minutes. DATA EXTRACTION: Each investigator provided definitions and exact data for outcome events. Odds ratios (ORs), 95% confidence intervals (CIs), and P values were calculated using exact tests for categorical data. DATA SYNTHESIS: Mortality at 30 days or less was 4.4% for the 1290 patients treated with primary angioplasty compared with 6.5% for the 1316 patients treated with thrombolysis (34% reduction; OR, 0.66; 95% CI, 0.46-0.94; P=.02). The effect was similar among thrombolytic regimens, and no subgroup demonstrated a significant reduction in death. The rates of death or nonfatal reinfarction were 7.2% for angioplasty and 11.9% for thrombolytic therapy (OR, 0.58; 95% CI, 0.44-0.76; P<.001). Angioplasty was associated with a significant reduction in total stroke (0.7% vs 2.0%; P=.007) and hemorrhagic stroke (0.1% vs 1.1%; P<.001). CONCLUSIONS: Based on outcomes at hospital discharge or 30 days, primary angioplasty appears to be superior to thrombolytic therapy for treatment of patients with acute myocardial infarction, with the proviso that success rates for angioplasty are as good as those achieved in these trials. Data evaluating longer-term outcomes, operator experience, and time delay before treatment are needed before primary angioplasty can be universally recommended as the preferred treatment.

Angioplasty, Balloon, Coronary↗
PubMed1997

Clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute myocardial infarction. Zwolle Myocardial infarction Study Group.

BACKGROUND: A simple clinical method to stratify risk for patients who have had successful reperfusion therapy after myocardial infarction is attractive since it facilitates the tailoring of therapy. METHODS: We investigated the clinical value of the 12-lead electrocardiogram (ECG), in 403 patients after successful reperfusion therapy by primary coronary angioplasty, in relation to infarct size measured by enzyme activity, left-ventricular function, and clinical outcome. ECGs were analysed to find the extent of the ST-segment-elevation resolution 1 h after reperfusion therapy. FINDINGS: A normalised ST segment was seen in 51% of patients, a partly normalised ST segment in 34%, and 15% had no ST-segment-elevation resolution. Enzymatic infarct size and ejection fraction were related to the extent of the early resolution of the ST segment. The relative risk of death among patients with no resolution compared with patients with a normalised ST segment was 8.7 (95% CI 3.7-20.1), and that among patients with partial resolution compared with patients with a normalised ST segment was 3.6 (1.6-8.3). INTERPRETATION: Our findings suggest that ECG patterns reflect the effectiveness of myocardial reperfusion. Patients for whom reperfusion therapy by primary angioplasty was successful and who had normalised ST segments had limited damage to the myocardium and an excellent outlook during follow-up. Patients with persistent ST elevation after reperfusion therapy may need additional interventions since they have more extensive myocardial damage and have a higher mortality rate.

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PubMed1997

Randomized comparison of primary coronary angioplasty with thrombolytic therapy in low risk patients with acute myocardial infarction.

OBJECTIVES: We sought to compare primary coronary angioplasty and thrombolysis as treatment for low risk patients with an acute myocardial infarction. BACKGROUND: Primary coronary angioplasty is the most effective reperfusion therapy for patients with acute myocardial infarction; however, intravenous thrombolysis is easier to apply, more widely available and possibly more appropriate in low risk patients. METHODS: We stratified 240 patients with acute myocardial infarction at admission according to risk. Low risk patients (n = 95) were randomized to primary angioplasty or thrombolytic therapy. The primary end point was death, nonfatal stroke or reinfarction during 6 months of follow-up. Left ventricular ejection fraction and medical charges were secondary end points. High risk patients (n = 145) were treated with primary angioplasty. RESULTS: In low risk patients, the incidence of the primary clinical end point (4% vs. 20%, p < 0.02) was lower in the group with primary coronary angioplasty than in the group with thrombolysis, because of a higher rate of reinfarction in the latter group. Mortality and stroke rates were low in both treatment groups. There were no differences in left ventricular ejection fraction or total medical charges. High risk patients had a 14% incidence rate of the primary clinical end point. CONCLUSIONS: Simple clinical data can be used to risk-stratify patients during the initial admission for myocardial infarction. Even in low risk patients, primary coronary angioplasty results in a better clinical outcome at 6 months than does thrombolysis and does not increase total medical charges.

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PubMed1997

Transferring patients for primary angioplasty: a retrospective analysis of 104 selected high risk patients with acute myocardial infarction.

OBJECTIVE: To investigate the feasibility of primary coronary angioplasty as a treatment option in patients with acute myocardial infarction after initial diagnosis in a local community hospital. SETTING: Referral centre for interventional treatment of coronary artery disease. METHODS: During a five year period, 520 candidates for primary coronary angioplasty were treated in our institution, 104 after transfer from a community hospital. The transferred patients and the non-transferred patients (n = 416) were compared with regard to baseline clinical characteristics, time interval from symptom onset to treatment, and clinical outcome at six months. RESULTS: In this setting, the influence of transportation on total ischaemic time was limited, and there was no difference in clinical outcome between the transferred and the non-transferred patients. Clinical outcome was mainly dependent on the indication for transfer. CONCLUSIONS: Safe and expedient transportation may facilitate the more widespread use of primary angioplasty in patients with acute myocardial infarction. A large randomised multicentre trial is needed to compare the relative merits of intravenous thrombolytic treatment in a local hospital with primary angioplasty after transfer in selected high risk patients with acute myocardial infarction.

Angioplasty, Balloon, Coronary↗
PubMed1997

Patency and reinfarction in late-entry myocardial infarct patients treated with reperfusion therapy.

Patency of the infarct-related vessel is associated with a more favorable long-term prognosis after acute myocardial infarction (AMI). High infarct vessel patency is reported for early reperfusion therapy, but data on patency and its possible effect on clinical outcome are less abundant for patients presenting late after the acute event. The aim of this study was to investigate whether time to reperfusion is related to infarct-vessel patency and clinical outcome. This study compares 268 patients who presented with symptoms of AMI within six hours after the onset of symptoms (Early) with 33 patients who had reperfusion therapy for signs of ongoing ischemia more than six hours after the start of chest pain (Late). At follow-up coronary angiography, flow through the infarct-related vessel was assessed according to the thrombolysis in myocardial infarction (TIMI) classification. Vessels were considered occluded if TIMI flow grade 0 or 1 was present. Follow-up angiography was performed in 95% of patients after a mean of forty-eight days. The infarct-related vessel was occluded in 41% of the late-entry patients (13 of 32), and in 17% of those presenting early (44 of 252), (P = 0.01; relative risk [RR]: 2.50; 95% confidence interval [CI]: 1.26 to 6.83). This was associated with a higher rate of recurrent myocardial infarction in late-entry patients: 27% (9 of 33), compared with 9% (25 of 268) in the early group (P = 0.005; RR: 2.94; 95% CI: 1.50 to 5.81). Thus, in the present study, late reperfusion therapy (after six hours) was associated with a higher recurrent myocardial infarction rate and a lower infarct vessel patency rate, compared with early treatment of patients.

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PubMed1997

Treating myocardial infarction in the post-GUSTO era. A European perspective.

In recent years, thrombolysis has been established as the treatment of choice for patients with evolving myocardial infarction. Reperfusion of ischaemic myocardium through reopening of the occluded infarct-related vessel results in limitation of infarct size and reduction of morbidity and mortality. The landmark Global Utilisation of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries (GUSTO-I) study, published in 1994, has identified a patent infarct vessel as the key to success of treatment. Opening the infarct vessel by means of coronary angioplasty or percutaneous transluminal coronary angioplasty (PTCA) was believed to be dangerous, expensive and ineffective and was only considered as an alternative when contraindications for thrombolytic treatment were present. However, recent reports from centres with experience in performing coronary angioplasty demonstrated superior results of primary coronary angioplasty (without additional or concomitant thrombolytic therapy) with regard to survival, morbidity and cost effectiveness, when compared with thrombolytic therapy. In hospitals with interventional cardiology facilities throughout Europe, this has resulted in a different attitude towards the treatment of patients with myocardial infarction. In a rapidly increasing number of European heart centres, primary coronary angioplasty is applied to reopen infarct vessels. This article tries to summarise the rationale for this approach.

Europe↗
PubMed1996

Mortality, reinfarction, left ventricular ejection fraction and costs following reperfusion therapies for acute myocardial infarction.

The comparative efficacy of thrombolytic drugs and primary angioplasty for acute myocardial infarction have recently been studied, but long-term follow-up data have not yet been reported. We conducted a randomized trial involving 301 patients with acute myocardial infarction; 152 patients were randomized to primary angioplasty and 149 to intravenous streptokinase. Left ventricular function was assessed with a radionuclide technique both at hospital discharge and at the end of the follow-up period. Follow-up data were collected after a mean (+/-SD) of 31 +/- 9 months. Total medical costs were calculated. At the end of the follow-up period, 5% of the angioplasty patients had died from a cardiac cause compared to 11% of the patients randomized to intravenous streptokinase, P = 0.031. Cardiac death or a non-fatal reinfarction occurred in 7% of angioplasty patients compared to 28% of streptokinase patients, P < 0.001. There was a sustained benefit of angioplasty compared to streptokinase on left ventricular function. The total medical costs in the two groups were similar. Coronary anatomy (patency and single or multivessel disease), infarct location and previous myocardial infarction were important determinants of clinical outcome and costs. After 31 +/- 9 months of follow-up, primary angioplasty compared to intravenous streptokinase results in a lower rate of cardiac death and reinfarction, a better left ventricular ejection fraction, and no increase in total medical costs.

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PubMed1995

[Favorable long-term results of primary percutaneous transluminal coronary angioplasty in acute myocardial infarction compared to intravenous streptokinase treatment; a randomized study].

OBJECTIVE: To evaluate the treatment of patients with acute myocardial infarction with thrombolytic drugs or primary angioplasty in a randomized trial. DESIGN: Randomized trial. SETTING: Hospital De Weezenlanden, Zwolle, the Netherlands. METHODS: A total of 301 patients with acute myocardial infarction were included in the trial, of whom 152 patients were allocated to primary angioplasty and 149 patients to intravenous streptokinase. The mean follow-up duration was 31 months (SD:9). Left ventricular function was assessed with a radionuclide technique before hospital discharge and at the end of the follow-up period. A cost analysis was performed based on the calculation of all medical costs. RESULTS: At the end of the follow-up period, 5% of the angioplasty patients had died from a cardiac cause compared with 11% of the patients randomized to intravenous streptokinase (p = 0.031). Death or non-fatal reinfarction occurred in 7% of angioplasty patients and in 28% of streptokinase patients (p < 0.001). There was a sustained beneficial effect of angioplasty in comparison with streptokinase on left ventricular function, 48 (SD12)% versus 43(SD13)% (p < 0.01). Most benefit was observed in patients with an anterior wall myocardial infarction. CONCLUSION: After an average of 31 months (SD:9) primary angioplasty in comparison with intravenous streptokinase resulted in a lower rate of cardiac death and reinfarction and a better left ventricular ejection fraction, without an increase in total costs.

Angioplasty, Balloon, Coronary↗
PubMed1995

Sensitivity of ovine myometrial tissue to various eicosanoids in vitro.

The sensitivity of sheep myometrial tissue to prostaglandin F2 alpha (PGE2 alpha), PGE2, the thromboxane analog U-44069, and leukotrienes C4 (LTC4) and LTD4 was investigated in a superfusion system. Tissues were obtained from eight oophorectomized ewes, with or without pretreatment with estradiol-17 beta. After equilibration, spontaneous activity was abolished by adding indomethacin to the superfusion fluid. The dose needed to induce a contraction with a peak level of 50% of the median peak level of spontaneous contractions increased from PGE2 to PGF2 alpha, U-44069, LTC4, and LTD4. The differences between the doses required were significant for all compounds, except between LTC4 and LTD4. Estradiol-17 beta pretreatment caused an increase in the required dose of PGF2 alpha. The results of this study do not support the hypothesis that leukotrienes are involved in the regulation of myometrial activity.

Animals↗
PubMed1995

Angiographic findings and catheterization laboratory events in patients with primary coronary angioplasty or streptokinase therapy for acute myocardial infarction.

BACKGROUND: The purpose of this study was to evaluate catheterization laboratory events and angiographic findings in patients randomly assigned to undergo primary coronary angioplasty or to receive intravenous streptokinase for acute myocardial infarction. METHODS: We analysed angiographic data in 301 patients with acute myocardial infarction, randomly assigned to undergo primary coronary angioplasty without antecedent thrombolytic therapy or to receive intravenous streptokinase therapy. Follow-up coronary angiography was preferably performed after 3 months. All angiograms were analysed with a quantitative coronary analysis system. RESULTS: Of the 152 patients assigned to angioplasty treatment, 140 underwent this procedure with a success rate of 97%. The residual diameter stenosis of the infarct-related vessel immediately after angioplasty was 27 +/- 15% and there were major events in 14% of the patients in the catheterization laboratory. At follow-up angiography after a mean interval of 92 days in the angioplasty assigned patients, a diameter stenosis of 35 +/- 22% was observed in this group. The restenosis rate was 28% and the reocclusion rate 5%. A Thrombolysis in Myocardial Infarction (TIMI) grade 2 flow immediately after angioplasty was predictive for reocclusion at follow-up (P = 0.001). In the streptokinase assigned patients (149) the infarct-related vessel was patent at follow-up angiography after a mean of 22 days in 66% of the patients with a mean residual diameter stenosis of 77 +/- 20%. CONCLUSION: Primary coronary angioplasty is a highly effective and safe reperfusion modality for patients with acute myocardial infarction. However, TIMI grade 2 flow through the infarct-related vessel immediately after angioplasty is a predictor of reocclusion.

Adult↗
PubMed1994

Immediate coronary angioplasty versus intravenous streptokinase in acute myocardial infarction: left ventricular ejection fraction, hospital mortality and reinfarction.

OBJECTIVES: The purpose of the present study was to compare intravenous streptokinase therapy with immediate coronary angioplasty without antecedent thrombolytic therapy with regard to left ventricular function and hospital mortality and reinfarction. BACKGROUND: Despite the widespread use of intravenous thrombolytic therapy and immediate percutaneous transluminal coronary angioplasty, these two strategies to treat patients with an acute myocardial infarction have only recently been compared in randomized trials. Coronary angioplasty has been shown to result in a higher patency rate of the infarct-related coronary artery, with a less severe residual stenotic lesion, compared with streptokinase therapy, but whether this more favorable coronary anatomy results in clinical benefit remains to be established. METHODS: We studied 301 patients with acute myocardial infarction randomly assigned to undergo immediate coronary angioplasty without antecedent thrombolytic therapy or to receive intravenous streptokinase therapy. Before discharge left ventricular ejection fraction was measured by radionuclide scanning. RESULTS: The in-hospital mortality rate in the streptokinase group was 7% (11 of 149 patients) compared with 2% (3 of 152 patients) in the angioplasty group (p = 0.024). In the streptokinase group recurrent myocardial infarction occurred in 15 patients (10%) versus in 2 (1%) in the angioplasty group (p < 0.001). Either death or nonfatal reinfarction occurred in 23 patients (15%) in the streptokinase group and in 5 patients (3%) in the angioplasty group (p = 0.001). Left ventricular ejection fraction was 44 +/- 11% (mean +/- SD) in the streptokinase group versus 50 +/- 11% in the angioplasty group (p < 0.001). CONCLUSIONS: These findings indicate that immediate coronary angioplasty without antecedent thrombolytic therapy results in better left ventricular function and lower risk of death and recurrent myocardial infarction than treatment with intravenous streptokinase.

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