European Heart Journal Advance Access originally published online on June 1, 2005
European Heart Journal 2005 26(18):1831-1837; doi:10.1093/eurheartj/ehi331
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Long-term clinical outcomes after rescue angioplasty are not different from those of successful thrombolysis for acute myocardial infarction
Department of Cardiology, Hôpital Bichat-Claude Bernard, Assistance Publique—Hôpitaux de Paris, 46 rue Henri Huchard, 75877 Paris Cedex 18, France
Received 20 September 2004; revised 22 March 2005; accepted 22 April 2005; online publish-ahead-of-print 1 June 2005.
* Corresponding author. Tel: +33 1 40 25 86 68; fax: +33 1 40 25 88 65. E-mail address: gabriel.steg{at}bch.ap-hop-paris.fr
See page 1813 for the editorial comment on this article (doi:10.1093/eurheartj/ehi382)
Aims The long-term value of rescue percutaneous transluminal coronary angioplasty (PTCA) in patients with ST-segment elevation myocardial infarction who received thrombolytic therapy but failed to achieve early recanalization of the artery is still debated. This study aimed to compare long-term outcomes after successful thrombolysis vs. systematic attempted rescue PTCA.
Methods and results A total of 362 consecutive patients with STEMI hospitalized within 6 h of symptom onset and treated with intravenous thrombolytic therapy were studied. Of these, 345 underwent coronary angiography within 90 min. Sixty per cent of patients achieved TIMI 3 flow and were treated medically; the in-hospital death rate in this group was 4%. Nine per cent of patients had TIMI 2 flow and 31% TIMI 0–1 flow. In this latter group, rescue PTCA was attempted in 85.8% with a hospital death rate of 5.5% (20% with failed vs. 4% with successful rescue PTCA, P=0.03). Eight year actuarial survival without recurrent myocardial infarction was no different in patients who had successful thrombolytic therapy and in patients with attempted rescue PTCA [78 and 95% CI (71–85) vs. 78 and 95% CI (68–87), respectively, hazard ratio: 0.93 (0.52–1.65), P=0.80]. Total mortality, cardiac mortality, and other composite endpoints also did not differ between groups.
Conclusion Routine attempted rescue PTCA 90 min after thrombolytic therapy in patients with persistent occlusion of the infarct-related vessels achieves long-term clinical outcomes which do not differ from those obtained by successful thrombolysis.
Key Words: PTCA • Angioplasty • Thrombolysis • Myocardial infarction
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