Intravenous thrombolysis before percutaneous coronary intervention in patients with non-ST-elevation acute coronary syndrome and acute ischaemic stroke: a subanalysis of the PRAISE study.

IF 2.8 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Open Heart Pub Date : 2025-09-29 DOI:10.1136/openhrt-2025-003567

Annahita Sedghi, Regina von Rennenberg, Gabor Petzold, Georg Nickenig, Bernd Kallmünzer, Stephan Achenbach, Roman Huber, Julia Seeger, Bettina von Sarnowski, Goetz Thomalla, Peter Arthur Ringleb, Dominik Michalski, Ulrich Laufs, Georg Royl, Kristina Szabo, Norman Mangner, Volker Puetz, Lars Kellert, Stefan Kaeaeb, Silke Wunderlich, Karl-Ludwig Laugwitz, Martina Petersen, Annerose Mengel, David M Leistner, Ulf Landmesser, Matthias Endres, Christian H Nolte, Timo Siepmann

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引用次数: 0

Abstract

Background: In patients with acute ischaemic stroke (AIS) and concomitant non-ST-elevation acute coronary syndrome (NSTE-ACS), the role of intravenous thrombolysis (IVT) before percutaneous coronary intervention (PCI) is unclear.

Methods: We performed a subanalysis of the PRAISE (PRediction of Acute coronary syndrome in acute Ischemic StrokE) study, a multicentre, prospective observational study in 247 patients with AIS and elevated high-sensitivity cardiac troponin who underwent coronary angiography based on European Society of Cardiology guidelines. The impact of IVT prior to PCI on coronary artery flow (Thrombolysis in Myocardial Infarction (TIMI) score) and myocardial perfusion (TIMI myocardial perfusion score) was compared using Fisher's exact test and logistic regression analysis, adjusting for time from stroke onset to PCI.

Results: Among 71 patients with AIS undergoing PCI, those who received IVT prior to PCI for NSTE-ACS (33 women; median age 77 (66-82 IQR)) achieved a TIMI grade 3 flow more frequently than those undergoing direct PCI (97% vs 79%; p=0.04). Regression analysis indicated a trend toward improved coronary artery flow with IVT (adjusted OR 8.5, 95% CI 0.9 to 75.3; p=0.05). Myocardial perfusion did not differ between groups (p=0.06).

Conclusions: This subanalysis suggests that IVT before PCI may enhance coronary artery flow in selected patients with NSTE-ACS with AIS. The results of this exploratory subanalysis warrant further investigation, particularly in patients with delayed access to PCI.

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非st段抬高急性冠状动脉综合征和急性缺血性卒中患者经皮冠状动脉介入治疗前静脉溶栓：PRAISE研究的亚分析

背景：在急性缺血性卒中（AIS）合并非st段抬高急性冠状动脉综合征（NSTE-ACS）患者中，经皮冠状动脉介入治疗（PCI）前静脉溶栓（IVT）的作用尚不清楚。方法：我们对PRAISE（急性缺血性卒中急性冠状动脉综合征预测）研究进行了亚分析，该研究是一项多中心前瞻性观察研究，根据欧洲心脏病学会指南，247例AIS患者和高敏感性心肌肌钙蛋白升高的患者接受了冠状动脉造影。采用Fisher精确检验和logistic回归分析比较PCI前IVT对冠状动脉血流（心肌梗死溶栓（TIMI）评分）和心肌灌注（TIMI心肌灌注评分）的影响，调整卒中发生至PCI的时间。结果：在71例接受PCI的AIS患者中，因NSTE-ACS而在PCI前接受IVT的患者（33名女性，中位年龄77岁（66-82 IQR））比直接接受PCI的患者更频繁地获得TIMI 3级血流（97% vs 79%; p=0.04）。回归分析显示IVT有改善冠状动脉血流的趋势（校正OR为8.5,95% CI为0.9 ~ 75.3;p=0.05）。心肌灌注组间差异无统计学意义（p=0.06）。结论：该亚组分析表明，PCI前IVT可能会增强NSTE-ACS合并AIS患者的冠状动脉血流。这一探索性亚分析的结果值得进一步研究，特别是在延迟接受PCI的患者中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Open Heart CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.60

自引率

3.70%

发文量

145

审稿时长

20 weeks

期刊介绍： Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.