Background Appropriate treatment strategy for ST-Segment elevation myocardial infarction patients who
have failed fibrinolytic therapy is uncertain.
Objective We tested the safety and efficacy of rescue PCI after failure of fibrinolysis.
Methods Sixty patients with acute ST-Segment elevation myocardial infarction were included in this
controlled, prospective study. We aimed to evaluate the safety and efficacy of rescue PCI
compared to conservative treatment in patients who initially received thrombolytic therapy
but without clinical and or electrocardiographic evidence of successful reperfusion 90 minutes
after start of fibrinolysis.
Results No mortality was reported in either group, no re-infarction, heart failure, stroke, recurrent
ischemia, need for urgent intervention, arrhythmia, or major bleeding during the hospital stay.
However, minor bleeding was 30%, 7% in rescue PCI and conservative group respectively
(P= 0.01). After 30 days, angina requiring hospitalization occurred in 30% in the conservative
group versus 7% in rescue PCI group (P= 0.01). Target vessel revascularization was higher in
conservative group (13%) than rescue PCI group (0%), (P= 0.02). Development of heart failure
occurred in 30% in conservative patients, compared to 20% in rescue PCI. Re-infarction occurred
in one patient only of the study population (conservative group). No reported cases of mortality.
Conclusions Rescue PCI is a safe, feasible, and effective treatment option for patients who had failed
fibrinolytic therapy. |
