title: Risk of bleeding complications is not increased in patients undergoing rescue versus primary percutaneous coronary intervention for acute myocardial infarction.
abstract: BACKGROUND
  Concern for major bleeding complications (MBC) may lead to withholding of anticoagulation and fibrinolytic therapy in preparation for primary percutaneous coronary intervention (PCI), potentially resulting in unacceptable delays in achieving reperfusion.
  
  
  OBJECTIVE
  The primary objective of this study was to evaluate MBC associated with primary and rescue PCI and how timing to revascularization affects this variable.
  
  
  METHODS
  We evaluated 659 consecutive patients presenting within 24 hours of an acute ST elevation myocardial infarctions (MI). One hundred and eighty-three patients presented for rescue PCI and 476 for primary PCI. Eighty-seven rescue PCI patients were treated within 6 hours of their first dose of fibrinolytic. Demographics, procedural variables, outcomes, and major adverse cardiovascular events (MACE) were compared between the primary and rescue PCI groups and between early and late presenters in the rescue PCI group.
  
  
  RESULTS
  We observed that the incidence of MBC was 8% in patients undergoing rescue PCI and 6% in primary PCI (P=0.35). There were no significant differences in bleeding associated with GP IIb/IIIa receptor antagonist use, procedural success, or MACE. Similarly, in patients presenting for early or late rescue PCI there was no significant difference in MBC, procedural success, or MACE.
  
  
  CONCLUSIONS
  We concluded that early or late rescue PCI and primary PCI have similar rates of MBC and overall in-hospital outcomes for patients presenting within 24 hours of acute MI. Delaying the timing of a rapid reperfusion strategy in an effort to decrease the incidence of MBC complications is generally not justified.
authors.affiliation: From the University of Texas Health Sciences Center and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Keith
authors.initials: K
authors.lastname: Ellis
authors.forename: Fernando
authors.initials: F
authors.lastname: Boccalandro
authors.forename: Sukesh
authors.initials: S
authors.lastname: Burjonroppa
authors.forename: Andreas
authors.initials: A
authors.lastname: Muench
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Giesler
authors.forename: Richard W
authors.initials: RW
authors.lastname: Smalling
authors.forename: Stefano
authors.initials: S
authors.lastname: Sdringola
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D013997:Time Factors