title: Early percutaneous coronary intervention after fibrinolysis for acute ST elevation myocardial infarction: results of two German multi-centre registries (ACOS and GOAL).
abstract: OBJECTIVE
  We evaluated the outcome of early percutaneous coronary intervention (PCI) after fibrinolysis in patients presenting with ST elevation myocardial infarction (STEMI) in clinical practice.
  
  
  RESULTS
  2230 consecutive patients with STEMI treated with fibrinolysis were divided into two groups: patients treated with fibrinolysis only (n = 1540) or with additional PCI (n = 690) within a median of 150 min. In-hospital mortality (9.3% versus 5.9%) and death/myocardial re-infarction (13.9% versus 9.7%) occurred significantly less often in the PCI group. After adjustment for the confounding factors in the propensity score analysis PCI did not significantly affect hospital mortality (OR 0.88, 95% CI 0.57-1.36) and death/myocardial re-infarction (OR 0.86, 95% CI 0.61-1.20) in the overall patients collective. Major bleeding complications were observed more often in the PCI group (7.3% versus 4.2%). In patients with a higher risk profile (TIMI risk score > or = 5) (n = 494) PCI was associated with a significant reduction of hospital mortality (OR 0.40, 95% CI 0.20-0.78) and death/myocardial re-infarction (OR 0.36, 95 % CI 0.19-0.67).
  
  
  CONCLUSIONS
  In the overall patients' collective early PCI after fibrinolysis is not associated with an improved clinical outcome. However, in patients with a higher risk profile an early invasive strategy is associated with a risk reduction for mortality and the combined endpoint of death/myocardial re-infarction.
authors.affiliation: Herzzentrum Ludwigshafen, Department of Cardiology. Ludwigshafen. Germany.
authors.forename: Timm
authors.initials: T
authors.lastname: Bauer
authors.forename: Oliver
authors.initials: O
authors.lastname: Koeth
authors.forename: Claus
authors.initials: C
authors.lastname: Jünger
authors.forename: Tobias
authors.initials: T
authors.lastname: Heer
authors.forename: Harm
authors.initials: H
authors.lastname: Wienbergen
authors.forename: Anselm
authors.initials: A
authors.lastname: Gitt
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012042:Registries; D015912:Thrombolytic Therapy; D016896:Treatment Outcome