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Primary versus rescue percutaneous coronary intervention in patients with acute myocardial infarction
G Gimelli1, A Kalra, M S Sabatine
1Cardiology Division, Massachusetts General Hospital, Boston 02114, USA.
Insights
Primary percutaneous coronary intervention (PCI) and rescue PCI for acute myocardial infarction (AMI) show similar 6-month clinical outcomes. Rescue PCI had longer reperfusion times but comparable composite endpoints to primary PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) management involves primary percutaneous coronary intervention (PCI) or thrombolysis.
- Rescue PCI is an option when initial thrombolysis for AMI fails.
Purpose of the Study:
- To compare angiographic and clinical outcomes between primary PCI and rescue PCI in AMI patients.
- Evaluate the efficacy and safety of rescue PCI versus primary PCI.
Main Methods:
- Retrospective comparison of 105 AMI patients undergoing primary PCI (60) or rescue PCI (45).
- Follow-up up to 6 months, assessing reperfusion times, TIMI flow, ejection fraction, and composite clinical endpoints.
- Stent use in 93% of patients; Glycoprotein IIb/IIIa inhibitors used in 53% (primary PCI) vs. 22% (rescue PCI).
Main Results:
- Rescue PCI group experienced significantly longer reperfusion delay (354 vs. 189 min).
- Lower post-procedure ejection fraction in rescue PCI group (47% vs. 53%).
- Similar composite endpoint rates (death, recurrent MI, repeat procedures, angina) at 6 months (26.7% vs. 35%).
Conclusions:
- Rescue PCI for failed thrombolysis in AMI demonstrates comparable 6-month clinical outcomes to primary PCI.
- Despite delays and lower initial ejection fraction, rescue PCI offers a similar long-term prognosis.
Objective:
To compare angiographic and clinical outcomes of patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI) versus rescue PCI following failed thrombolysis.
Background:
Patients presenting with AMI are treated either with primary PCI or with thrombolysis. When thrombolysis fails, rescue PCI is performed.
Methods And Results:
We compared the outcome of 105 consecutive patients with AMI who underwent either primary PCI (60 patients) or rescue PCI (45 patients) between January 1997 and January 1999. The patients were followed for up to 6 months. Time delay to reperfusion was significantly longer in the rescue PCI group (354 vs. 189 min; p < 0.001). The majority of patients received a stent (93%). Glycoprotein (GP) IIb/IIIa inhibitors were used in 53% of patients in the primary PCI group and in 22% in the rescue group. TIMI grade 3 flow was achieved in 93.3% of patients in the primary PCI group and in 88.8% in the rescue group (p = 0.08). Post-procedure ejection fraction was 53% in the primary PCI group and 47% in the rescue group (p = 0.014). A composite endpoint of death, recurrent MI, repeat PCI, coronary artery bypass grafting (CABG) and recurrent angina at 6 months occurred in 35% of the patients in the primary PCI group and 26.7% in the rescue group (p = 0.36).
Conclusion:
Despite a significant delay to reperfusion and a lower immediate post-procedure ejection fraction, the clinical outcome of patients treated with rescue PCI following failed thrombolysis appears to be similar to that of patients treated with primary PCI at 6 months.