title: A randomized trial of coronary stenting versus balloon angioplasty as a rescue intervention after failed thrombolysis in patients with acute myocardial infarction.
abstract: OBJECTIVE
  This study was conducted to assess whether coronary stenting produces better results compared with balloon angioplasty in patients with acute myocardial infarction (AMI) after failed thrombolysis.
  
  
  BACKGROUND
  Little evidence exists on the value of rescue mechanical reperfusion after failed thrombolysis.
  
  
  METHODS
  This open-label, randomized study enrolled 181 patients with AMI referred for failed thrombolysis performed within the previous 24 h. The patients had to have a Thrombolysis In Myocardial Infarction (TIMI) flow grade of <or=2 in coronary angiography. Patients were randomly assigned to coronary stenting (90 patients) or coronary balloon angioplasty (91 patients). Salvage index (proportion of initial perfusion defect salvaged by rescue intervention), which was obtained by paired scintigraphic studies performed 7 to 10 days apart, was the primary end point of the trial. One-year clinical follow-up was assessed.
  
  
  RESULTS
  Myocardial salvage index (median [25th, 75th percentiles]) was significantly greater in the stent group than in the angioplasty group (0.35 [0.24, 0.56] vs. 0.25 [0.04, 0.43]; p = 0.005). Major bleeding occurred in four patients (4%) in the stent group and four patients (4%) in the angioplasty group. One-year mortality was 8% (7 patients) in the stent group versus 12% (11 patients) in the angioplasty group (relative risk, 0.6; 95% confidence interval 0.2 to 1.6; p = 0.35).
  
  
  CONCLUSIONS
  Patients with AMI and failed thrombolysis benefit from rescue mechanical reperfusion in terms of myocardial salvage. Coronary stenting is associated with a greater myocardial salvage in this setting compared with coronary balloon angioplasty.
authors.affiliation: Deutsches Herzzentrum, Medizinische Klinik rechts der Isar, Technische Universität, Munich, Germany. aschoemig@dhm.mhn.de <aschoemig@dhm.mhn.de>
authors.forename: Albert
authors.initials: A
authors.lastname: Schömig
authors.forename: Gjin
authors.initials: G
authors.lastname: Ndrepepa
authors.forename: Julinda
authors.initials: J
authors.lastname: Mehilli
authors.forename: Josef
authors.initials: J
authors.lastname: Dirschinger
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Nekolla
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.forename: Stefan
authors.initials: S
authors.lastname: Martinoff
authors.forename: Melchior
authors.initials: M
authors.lastname: Seyfarth
authors.forename: Markus
authors.initials: M
authors.lastname: Schwaiger
authors.forename: Adnan
authors.initials: A
authors.lastname: Kastrati
mesh_terms: D000800:Angioplasty, Balloon; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D011877:Radionuclide Imaging; D012720:Severity of Illness Index; D015607:Stents; D015912:Thrombolytic Therapy; D017211:Treatment Failure; D016896:Treatment Outcome