For every 10 minutes of delay in angioplasty, infarction mortality is increased by 10%.

Spain, March of 2013. A new way of addressing the acute myocardial infarction (AMI) in their first moments based on studies carried out by Spanish researchers from the now called RIC (Cardiovascular Research Network) was submitted months ago and recommended by the action guides in Ami of the European society of Cardiology and the American College of Cardiology/American Heart Association.

At the plenary session of annual of the Association American Cardiology Congress taking place in these days, you are now presented the study STREAM, developed by a multidisciplinary group of international researchers, published in the New England Journal of Medicine and which ratifies the procedure devised by Spanish researchers.

STREAM is a study to optimize the management of acute myocardial infarction in its first moments, looking for strategies that will reduce the delays in the implementation of the measures for reopening coronary artery whose occlusion occurred infarction (“guilty artery”). Every minute of delay in the implementation of these measures has a very high impact on mortality in the short and long term of these patients.

According to Prof. Francisco Fernández-Avilés, head of the cardiology department of the Hospital Gregorio Marañón and the ICM Coordinator, the ideal treatment of Ami is to achieve the opening of culprit artery and unblock it mechanically with a small balloon to insert a stent (primary angioplasty). But this technique, as well as complex, requires hospitals with high technological endowments and very trained teams, which, overall, only is available to less than half of patients who suffer a heart attack. In addition, often is done with a delay of more than recommended, which seriously affects the prognosis of these patients. For example, has been shown that for every 10 minutes of delay in angioplasty infarction mortality increases by 10% ”.

prof. Francisco Fernandez-Aviles.

STREAM study compares with another strategy called reperfusion drug-invasive primary angioplasty and is immediately given clot buster to open the artery, before moving the patient to a hospital with a capacity to complete the treatment with the definitive repair of culprit coronary artery angioplasty.

The main advantage of this strategy is to be an excellent alternative to primary Angioplasty for patients who do not have access to primary Angioplasty for logistical reasons ” says Fernández-Avilés for whom these patients be treated immediately with a thrombolytic and could move after not urgently to a Center in your area or another to complete the treatment. On the other part, when there is possibility of primary angioplasty, but this cannot be at the established time, the strategy drug-invasive opens the artery immediately with the thrombolytic, what must be completed obligatorily carried out in all cases a catheterization and if necessary, repair the coronary tree definitely through stent or surgical revascularization ”.

In the STREAM have participated 1.892 patients who were identified by the medical services until they transcurriesen 3 hours since the beginning of the stroke, in which you know that thrombolytics are very effective. This patients were assigned primary angioplasty or reperfusion drug-invasive and has compared its evolution within 30 days in terms of death, re-infarto, heart failure or shock. The used tromobolitico was tenecteplase (TNK), of high efficiency and very simple to manage

has resulted in patients assigned to the strategy drug-invasive have less incidence of reinfarction, heart failure, or death compared with those allocated but with a slightly higher incidence of bleeding, which disappears when cut in half the dose of thrombolytic in patients older than 75 years. In fact, when the results are analyzed after this dose reduction, the difference in favor of the drug invasive strategy is clearly significant.

For Fernández-Avilés these findings are of great clinical importance and health planning, since they demonstrate convincingly that there is an excellent alternative to primary angioplasty strategy that can benefit those patients who do not have access to primary angioplasty as well as those cases with access but in which unacceptable delays are expected. All reinforces the recommendations of relevant performance guidelines (European society of Cardiology, American College of Cardiology/American Heart Association) and must be taken into account both by physicians who serve this type of sick people in hospital emergency departments or mobile (112(, SUMMA, SAMUR, etc) as by health planners responsible for organizing local networks for the care of myocardial ”.

Is also excellent news for the formerly RECAVA now known as network Research Cardiovascular (RIC) of the Instituto de Salud Carlos III, because the definition and development strategy drug-invasive, collecting already guides and now devotes the study STREAM, it has been one of the most important achievements of this network who developed the grace (Group’s analysis of the fitness studiosIA acute ischemic).

Grace 1, 2 and 3 studies included over 1500 patients, with results published in journals such as Lancet or European Heart Journal, showing that the drug invasive strategy is safe and effective.

At this time the RIC is developing the grace-4, very similar to the STREAM but study focused on patients with infarction that are identified with more than 3 hours from the onset of symptoms.