title: Rescue percutaneous coronary intervention after failed thrombolysis: results from the Acute Coronary Syndrome Israel Surveys (ACSIS).
abstract: BACKGROUND
  The benefit of rescue percutaneous coronary intervention (PCI) in acute myocardial infarction patients, who fail to show signs of reperfusion after full dose thrombolysis, is still an unresolved issue.
  
  
  OBJECTIVE
  To assess the outcomes of patients who underwent rescue PCI after full-dose thrombolytic therapy and compare them to patients treated only with thrombolysis in the Acute Coronary Syndrome Israel Surveys (ACSIS).
  
  
  METHODS
  ACSIS is a biannual survey on acute myocardial infarction performed in all 26 intensive cardiac care units in Israel during a two-month period. 2,018 patients were admitted with acute myocardial infarction during the two-month period in the 2000 and 2002 surveys, and 796 of them were treated with thrombolytic therapy.
  
  
  RESULTS
  Rescue PCI was performed in 99 patients who failed to show signs of reperfusion. The control group consisted of patients with unsuccessful thrombolysis and no further intervention. Patients who underwent rescue PCI had a numerically higher incidence of anterior wall myocardial infarction, diabetes, higher Killip class on admission and cardiogenic shock. Furthermore, almost half of these patients had reduced left ventricular function (P = 0.03). During hospitalization, there was a significantly higher prevalence of recurrent ischemic events and major bleeding complications in patients who underwent rescue PCI. In-hospital, 30-day and one-year mortality rates were similar between the two groups. By multivariate analyses, Killip class 3-4 (OR: 2.62, CI = 0.95-6.58, P = 0.05) and streptokinase treatment (OR: 0.623, CI = 0.4-0.97, P = 0.05) were independent predictors of rescue PCI. Rescue angioplasty was associated with 15% risk-reduction (CI = 0.45-1.97, P = 0.05) in 30-day mortality and recurrent emergent hospitalization.
  
  
  CONCLUSIONS
  Patients who underwent rescue PCI had similar short- and long-term mortality rates compared to patients treated with thrombolysis alone, despite differences in baseline characteristics. Rescue angioplasty was associated with a 15% risk reduction in mortality at 30-days, at the cost of higher rate of recurrent ischemic events and bleeding complications. Therefore, rescue angioplasty may be an equalizer in severely ill patients who receive thrombolytic therapy and fail to show signs of reperfusion.
authors.affiliation: Division of Invasive Cardiology, Rambam Medical Center, Haifa, Israel.
authors.forename: Sergei
authors.initials: S
authors.lastname: Yalonetsky
authors.forename: Luis
authors.initials: L
authors.lastname: Gruberg
authors.forename: Amir
authors.initials: A
authors.lastname: Sandach
authors.forename: Haimm
authors.initials: H
authors.lastname: Hammerman
authors.forename: Rafael
authors.initials: R
authors.lastname: Beyar
authors.forename: Hanoch
authors.initials: H
authors.lastname: Hod
authors.forename: Shlomo
authors.initials: S
authors.lastname: Behar
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D003625:Data Collection; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D016879:Salvage Therapy; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000009:adverse effects; D017211:Treatment Failure