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Prehospital Thrombolysis: A Manual from Berlin
05:52

Prehospital Thrombolysis: A Manual from Berlin

Published on: November 26, 2013

Rescue percutaneous coronary intervention for failed thrombolysis: results from a district general hospital

K P Balachandran1, J Miller, A C H Pell

  • 1Lanarkshire Cardiac Catheterisation Laboratories, Hairmyres Hospital, Eaglesham Road, East Kilbride G75 8RG, UK.

Postgraduate Medical Journal
|August 2, 2002
PubMed

Insights

Emergency percutaneous coronary intervention (PCI) after failed thrombolysis in acute myocardial infarction shows good outcomes. This approach is safe and effective even without on-site surgical backup, offering a viable treatment strategy.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Myocardial Infarction Management

Background:

  • Failed reperfusion after thrombolysis in acute myocardial infarction (AMI) is associated with poor prognosis.
  • Timely intervention is crucial for improving outcomes in AMI patients.

Purpose of the Study:

  • To evaluate the clinical outcomes of emergency percutaneous coronary intervention (PCI) in patients with AMI and electrocardiographic (ECG) evidence of failed reperfusion.
  • To assess the safety and efficacy of this strategy in a district general hospital setting without on-site surgical backup.

Main Methods:

  • An observational study involving 109 consecutive patients with AMI undergoing emergency angiography and PCI for failed reperfusion.
  • Standard ECG criteria were used to diagnose failed reperfusion.
  • Outcomes assessed included in-hospital mortality, death, reinfarction, revascularization (PCI or CABG), and resource utilization during a mean follow-up of 30 months.

Main Results:

  • Successful reperfusion (TIMI 3 flow) was achieved or maintained in 85% of patients.
  • Overall in-hospital mortality was 9%, significantly higher in patients with cardiogenic shock (50%) and those with unsuccessful procedures (40%).
  • Over 30 months, 19 further events occurred, including one death, five reinfarctions, and 13 revascularizations. The cost of rescue PCI was comparable to elective interventions.

Conclusions:

  • Emergency angiography and PCI for failed reperfusion in AMI can be successfully implemented in hospitals without on-site surgical backup.
  • This policy leads to good medium-term clinical outcomes for patients with acute myocardial infarction.
Abstract

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