Early percutaneous coronary intervention after fibrinolysis for acute ST elevation myocardial infarction: results of two German multi-centre registries (ACOS and GOAL).
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.
Bauer
Timm
T
Herzzentrum Ludwigshafen, Department of Cardiology. Ludwigshafen. Germany.
Koeth
Oliver
O
Jünger
Claus
C
Heer
Tobias
T
Wienbergen
Harm
H
Gitt
Anselm
A
Senges
Jochen
J
Zeymer
Uwe
U
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