title: Ten-year experience with early angioplasty in 759 patients with acute myocardial infarction.
abstract: OBJECTIVE
  How effective and safe is rescue percutaneous transluminal coronary angioplasty [PTCA] compared with primary PTCA, and is it cost effective?
  
  
  BACKGROUND
  In acute myocardial infarction (AMI), primary PTCA has been shown to be beneficial in terms of clinical outcome. In contrast, the value of rescue PTCA has not been established.
  
  
  METHODS
  In a retrospective analysis, we compared the angiographic and clinical outcomes of 317 consecutive patients who had rescue PTCA approximately 90 min after failed thrombolysis and 442 patients treated with primary PTCA. An estimation of interventional costs was compared with the strategies of primary and rescue PTCA or with the strategy of thrombolysis with rescue PTCA, when indicated.
  
  
  RESULTS
  Baseline characteristics between primary and rescue PTCA were comparable for most variables. Treatment delay was longer for patients who had rescue PTCA: 240 min. versus 195 min. Coronary patency after PTCA was comparable: 90.2% for rescue PTCA and 91.4% for primary PTCA (p = 0.67, power 71.9%). In-hospital mortality rates were 4.7% and 6.6%, respectively (p = 0.37). Also, the other complications were fairly similar during the in-hospital phase and during one-year follow-up. Predictors of death were age, infarct size, localization of AMI, failed PTCA and left main stem occlusion. The estimated interventional costs during one-year follow-up were $7,377 for primary PTCA and $8,246 for rescue PTCA: difference $869 (11.7%).
  
  
  CONCLUSIONS
  In this retrospective analysis of 759 patients with AMI, rescue angioplasty early after failed thrombolysis seems to be as effective and safe as primary PTCA. In the present evaluation, interventional costs of primary PTCA are less than those of rescue PTCA (p = 0.0001).
authors.affiliation: University Hospital Maastricht and Cardiovascular Research Institute Maastricht, The Netherlands. f.baer@cardio.azm.nl
authors.forename: F
authors.initials: F
authors.lastname: Bär
authors.forename: J
authors.initials: J
authors.lastname: Vainer
authors.forename: J
authors.initials: J
authors.lastname: Stevenhagen
authors.forename: K
authors.initials: K
authors.lastname: Neven
authors.forename: R
authors.initials: R
authors.lastname: Aalbregt
authors.forename: T O
authors.initials: TO
authors.lastname: Ophuis
authors.forename: V
authors.initials: V
authors.lastname: van Ommen
authors.forename: H
authors.initials: H
authors.lastname: de Swart
authors.forename: E
authors.initials: E
authors.lastname: de Muinck
authors.forename: W
authors.initials: W
authors.lastname: Dassen
authors.forename: H
authors.initials: H
authors.lastname: Wellens
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000401:mortality; D017023:Coronary Angiography; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome