title: Failure of thrombolysis: experience with a policy of early angiography and rescue angioplasty for electrocardiographic evidence of failed thrombolysis.
abstract: OBJECTIVE
  To assess the outcome of a policy of emergency coronary angiography with or without rescue angioplasty in patients with acute myocardial infarction and ECG evidence of failed reperfusion after thrombolysis.
  
  
  METHODS
  A cohort study.
  
  
  METHODS
  Regional cardiothoracic unit.
  
  
  METHODS
  197 patients with acute myocardial infarction fulfilling a simple ECG criterion of failed reperfusion.
  
  
  METHODS
  Emergency coronary angiography proceeding to rescue angioplasty for inadequate antegrade flow.
  
  
  METHODS
  Hospital mortality for all 197 patients; incidence of successful and failed rescue angioplasty; need for additional revascularisation in those receiving rescue angioplasty compared with those not treated in this way.
  
  
  RESULTS
  197 patients had emergency angiography for ECG evidence of failed reperfusion; 156 patients received immediate rescue angioplasty. Overall hospital mortality for those undergoing rescue angioplasty was 11.5%. Rescue angioplasty achieved TIMI 2 (11) or TIMI 3 (124) in 135 patients, who had a hospital mortality of 5.9%. Failure to achieve at least TIMI 2 flow following rescue angioplasty occurred in 21 patients, with a hospital mortality of 48%. In the 41 patients in whom immediate rescue angioplasty was not performed, reinfarction or requirement for revascularisation occurred in 37%. Reinfarction occurred in three patients (1.9%) who had immediate rescue angioplasty. Hospital mortality for the whole cohort was 10.7%.
  
  
  CONCLUSIONS
  A policy of emergency coronary angiography proceeding to rescue angioplasty where appropriate reduces mortality in a high risk group to a level less than expected for patients with acute myocardial infarction and ECG evidence of failed reperfusion. Unsuccessful rescue angioplasty is associated with a high mortality.
authors.affiliation: Cardiothoracic Division, South Cleveland Hospital, Middlesbrough, UK.
authors.forename: A G
authors.initials: AG
authors.lastname: Sutton
authors.forename: P G
authors.initials: PG
authors.lastname: Campbell
authors.forename: E D
authors.initials: ED
authors.lastname: Grech
authors.forename: D J
authors.initials: DJ
authors.lastname: Price
authors.forename: A
authors.initials: A
authors.lastname: Davies
authors.forename: J A
authors.initials: JA
authors.lastname: Hall
authors.forename: M J
authors.initials: MJ
authors.lastname: Stewart
authors.forename: M A
authors.initials: MA
authors.lastname: de Belder
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002985:Clinical Protocols; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D019233:Retreatment; D016879:Salvage Therapy; D015912:Thrombolytic Therapy / Q000379:methods*; D017211:Treatment Failure