title: Early and long term outcome of rescue percutaneous coronary intervention (R-PCI): experience from a tertiary care center in Pakistan: outcome of rescue angioplasty in Pakistan.
abstract: BACKGROUND
  Thrombolysis is the standard of care for STEMI in Pakistan. Failed thrombolysis has a very high morbidity and mortality. Rescue PCI then remains the only option to salvage the myocardium. We sought to analyze the angiographic, immediate and long term clinical outcome of patients undergoing Rescue PCI at our institution in Karachi, Pakistan.
  
  
  METHODS
  58 consecutive patients who underwent rescue PCI for failed thrombolysis between 2002 and 2005 were reviewed. Clinical characteristics, angiographic and procedural details with clinical outcomes including total mortality, recurrent angina, and repeat revascularization were studied. Sources included cardiac catheterization lab database, medical records and follow up at outpatient clinics.
  
  
  RESULTS
  Rescue PCI was performed in 58 patients with a mean age 55 +/- 12 years with 47 (79%) male and 11 (21%) females. CAD risk factors were hypertension (53%), dyslipidemia (48%), smoking (34%) and diabetes (34%). 53% had anterior MI, 39% inferior and 8% had a lateral wall MI. The median time frames were: onset of chest pain to ER = 99 min, door to needle time = 35 min, ER to procedure start time = 250 min. The culprit vessels were: Left Anterior Descending (LAD) (53%), Right Coronary Artery (RCA) (32%) and Circumflex (CX) (15%). TIMI flow grades pre-procedural were 0/I = 52%, II = 34%, III = 14% and post procedure 0/I = 8%, II = 6%, III = 86%. The mean follow-up duration was 16.15 months at which 50 (86%) were alive and 43 (74.13%) had event free survival.
  
  
  CONCLUSIONS
  Procedural success, event free survival and mortality in our series of Rescue PCI from Pakistan are comparable to recent international trials and registries. It should be considered as a reasonable option for patients with failed thrombolysis.
authors.affiliation: Internal Medicine, University of Wisconsin Hospital and Clinics, Madison, WI 53705, USA. a.hakeem@hosp.wisc.edu
authors.forename: Abdul
authors.initials: A
authors.lastname: Hakeem
authors.forename: Sajid
authors.initials: S
authors.lastname: Dhakam
authors.forename: Javed
authors.initials: J
authors.lastname: Tai
authors.forename: Humayun
authors.initials: H
authors.lastname: Bakhtawar
authors.forename: Muhammad Haris
authors.initials: MH
authors.lastname: Nazim
authors.forename: Shehzad
authors.initials: S
authors.lastname: Raza
authors.forename: Sabha
authors.initials: S
authors.lastname: Bhatti
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome