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Predictors of infarct artery patency after prehospital thrombolysis. The multicentre, prospective, observational OPTIMAL study
  1. Vanina Bongard (bongard{at}cict.fr)
  1. Centre Hospitalier Universitaire de Toulouse - INSERM U558, France
    1. Jacques Puel
    1. Centre Hospitalier Universitaire de Toulouse, France
      1. Dominique Savary
      1. Centre Hospitalier d'Annecy, France
        1. Loic Belle
        1. Centre Hospitalier d'Annecy, France
          1. Sandrine Charpentier
          1. Centre Hospitalier Universitaire de Toulouse, France
            1. Yves Cottin
            1. Centre Hospitalier Universitaire de Dijon, France
              1. Louis Soulat
              1. Centre Hospitalier de Chateauroux, France
                1. Meyer Elbaz
                1. Centre Hospitalier Universitaire de Toulouse, France
                  1. Darko Miljkovic
                  1. Boehringer-Ingelheim, France
                    1. Philippe-Gabriel Steg
                    1. INSERM U-698, AP-HP, Universite Paris 7, France

                      Abstract

                      Objective: To identify predictors of early TIMI 3 flow patency of the infarct-related artery following prehospital thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI) using data from a 'real-world' population, and to develop a nomogram for triaging patients to emergency angiography.

                      Design: Multicenter, observational, prospective, cohort study.

                      Setting: 79 hospitals in France with a prehospital mobile intensive care unit and a coronary care unit with 24-hour access to coronary angiography.

                      Patients: 997 patients with STEMI.

                      Interventions: All patients received prehospital thrombolysis within 6 hours of symptom onset and angiography was performed within 6 hours of thrombolysis.

                      Main outcome measures: Coronary patency (TIMI flow).

                      Results: The median age of the population was 59 years and the sample comprised 18% of women. After multivariable logistic regression analysis, predictors of TIMI 3 flow in the infarct-related artery were current/previous smoking (odds ratio (OR) 1.60, 95% confidence interval 1.15-2.22), <=5 leads with ST-segment elevation before thrombolysis (OR=1.59, 1.12-2.25), Killip class I (OR=1.96, 1.05-3.67), chest pain relief (OR=1.62, 1.17-2.25), and ST-segment resolution >=70% (OR=1.76, 1.29-2.38). A nomogram was developed to assess the probability of TIMI 3 flow, according to smoking status, number of leads with ST-elevation before thrombolysis, killip class, chest pain relief, and ST-segment resolution.

                      Conclusions: This study provides quantitative data for predicting success of prehospital thrombolysis. The nomogram is a simple tool for predicting likelihood of coronary patency, based on clinical and electrocardiographic data. It may help identify patients who require emergency angiography and rescue PCI.

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                      • Web only appendix 95;10:799-804

                        • Web only appendix 95;10:799-804

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