Rescue percutaneous coronary intervention for failed thrombolysis: results from a district general hospital.
OBJECTIVE
To assess the outcome of a policy of emergency percutaneous coronary intervention (PCI) in patients with acute myocardial infarction and electrocardiographic (ECG) evidence of failed reperfusion after thrombolysis.


METHODS
Observational study.


METHODS
District general hospital.


METHODS
A total of 109 consecutive patients with acute myocardial infarction who underwent emergency angiography and angioplasty for failed reperfusion diagnosed on the basis of standard ECG criteria.


METHODS
In-hospital mortality; death, infarct territory reinfarction, and reintervention by PCI or coronary artery bypass graft (CABG) during follow up; in-lab resource utilisation.


RESULTS
At initial angiography, 76 patients had Thrombolysis in Myocardial Infarction (TIMI) trial 0/1 flow and 33 had TIMI 2/3 flow. Fourteen patients were in cardiogenic shock. TIMI 3 flow was established or maintained in 93 patients (85%). Overall in-hospital mortality was 9%. It was 3% in non-shock patients, 50% in shocked patients, and 40% when the procedure was unsuccessful (TIMI 0/1 flow post-procedure). Over a mean follow up of 30 months (>12 months of follow up in all patients) there were 19 further events (one death, five reinfarctions, and 13 revascularisations (nine CABG and four PCI)). The cost of rescue PCI was not significantly higher than comparable elective interventions.


CONCLUSIONS
A policy of emergency angiography and PCI for failed reperfusion in acute myocardial infarction can be carried out in a hospital without on-site surgical backup with good medium term clinical outcomes.
Balachandran
K P
KP
Lanarkshire Cardiac Catheterisation Laboratories, Hairmyres Hospital, Eaglesham Road, East Kilbride G75 8RG, UK.
Miller
J
J
Pell
A C H
AC
Vallance
B D
BD
Oldroyd
K G
KG
D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D017211:Treatment Failure; D016896:Treatment Outcome