Failure of thrombolysis: experience with a policy of early angiography and rescue angioplasty for electrocardiographic evidence of failed thrombolysis.
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.
Sutton
A G
AG
Cardiothoracic Division, South Cleveland Hospital, Middlesbrough, UK.
Campbell
P G
PG
Grech
E D
ED
Price
D J
DJ
Davies
A
A
Hall
J A
JA
Stewart
M J
MJ
de Belder
M A
MA
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