Rescue percutaneous coronary intervention for failed thrombolysis

Area of Science:

• Cardiology
• Interventional Cardiology
• Acute Coronary Syndromes

Background:

• Conflicting results exist regarding rescue percutaneous coronary intervention (PCI) following failed thrombolysis.
• The outcomes of high-risk patients undergoing rescue PCI in the current era of advanced therapies are not well-characterized.

Purpose of the Study:

• To characterize the outcomes of patients undergoing rescue PCI after failed thrombolysis using contemporary interventional techniques.
• To evaluate the safety and efficacy of rescue PCI in a real-world setting.

Main Methods:

• A retrospective review of 214 consecutive patients who underwent emergent coronary angiography after failed thrombolysis from January 2000 to October 2004.
• 178 patients underwent PCI, with data collected on in-hospital events including bleeding, stroke, recurrent ischemia, myocardial infarction, target vessel revascularization, and death.

Main Results:

• The study cohort was critically ill, with high rates of cardiac arrest and cardiogenic shock.
• Contemporary treatments including coronary stents (88%), glycoprotein IIb/IIIa inhibitors (92%), and intra-aortic balloon pumps (17%) were frequently used.
• Rescue PCI demonstrated high angiographic (90%) and clinical success (85%) with low rates of bleeding complications (7.3%), stroke (1.7%), and in-hospital mortality (3.4%).

Conclusions:

• Contemporary rescue PCI for failed thrombolysis is associated with high procedural success and favorable clinical outcomes.
• Low rates of major adverse cardiac events and mortality suggest that rescue PCI is a viable strategy in this high-risk population.
• Prospective, randomized trials are warranted to further evaluate contemporary interventional therapies for rescue PCI.