title: Thorombolytic therapy with rescue percutaneous coronary intervention versus primary percutaneous coronary intervention in patients with acute myocardial infarction: a multicenter randomized clinical trial.
abstract: BACKGROUND
  Although thrombolytic therapy with rescue percutaneous coronary intervention (PCI) is a common treatment strategy for ST-segment elevation acute myocardial infarction (STEMI), scant data are available on its efficacy relative to primary PCI, and comparison was therefore the aim of this study.
  
  
  METHODS
  This multicenter, open-label, randomized, parallel trial was conducted in 12 hospitals on patients (age < or = 70 years) with STEMI who presented within 12 hours of symptom onset (mean interval > 3 hours). Patients were randomized to three groups: primary PCI group (n = 101); recombinant staphylokinase (r-Sak) group (n = 104); and recombinant tissue-type plasminogen activator (rt-PA) group (n = 106). For all patients allocated to the thrombolytic therapy arm, coronary angiography was performed at 90 minutes after drug therapy to confirm infarct-related artery (IRA) patency; rescue PCI was performed in cases with TIMI flow grade < or = 2. Bare-metal stent implantation was planned for all patients.
  
  
  RESULTS
  After randomization it required an average of 113.4 minutes to start thrombolytic therapy (door-to-needle time) and 141.2 minutes to perform first balloon inflation in the IRA (door to balloon time). Rates of IRA patency (TIMI flow grade 2 or 3) and TIMI flow grade 3 were significantly lower in the thrombolysis group at 90 minutes after drug therapy than in the primary PCI group at the end of the procedure (70.5% vs. 98.0%, P < 0.0001, and 53.0% vs. 85.9%, P < 0.0001, respectively). Rescue PCI with stenting was performed in 117 patients (55.7%) in the thrombolytic therapy arm. Rates of patency and TIMI flow grade 3 were still significantly lower in the rescue PCI than in the primary PCI group (88.9% vs. 97.9%, P = 0.0222, and 68.4% vs. 85.0%, P = 0.0190, respectively). At 30 days post-therapy, mortality rate was significantly higher in the thrombolysis combined with rescue PCI group than in primary PCI group (7.1% vs. 0, P = 0.0034). Rates of death/MI and bleeding complications were significantly higher in the thrombolysis with rescue PCI group than in the primary PCI group (10.0% vs. 1.0%, P = 0.0380, and 28.10% vs. 8.91%, P = 0.0001, respectively).
  
  
  CONCLUSIONS
  Thrombolytic therapy with rescue PCI was associated with significantly lower rates of coronary patency and TIMI flow grade 3, but with significantly higher rates of mortality, death/MI and hemorrhagic complications at 30 days, as compared with primary PCI in this group of Chinese STEMI patients with late presentation and delayed treatments.
authors.affiliation: Department of Cardiology, Cardiovascular Institute & Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China. gaorunlin@263.net
authors.forename: Run-lin
authors.initials: RL
authors.lastname: Gao
authors.forename: Ya-ling
authors.initials: YL
authors.lastname: Han
authors.forename: Xin-chun
authors.initials: XC
authors.lastname: Yang
authors.forename: Jie-ming
authors.initials: JM
authors.lastname: Mao
authors.forename: Wei-yi
authors.initials: WY
authors.lastname: Fang
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Wei-feng
authors.initials: WF
authors.lastname: Shen
authors.forename: Zhan-quan
authors.initials: ZQ
authors.lastname: Li
authors.forename: Guo-liang
authors.initials: GL
authors.lastname: Jia
authors.forename: Shu-zheng
authors.initials: SZ
authors.lastname: Lü
authors.forename: Meng
authors.initials: M
authors.lastname: Wei
authors.forename: Ding-yin
authors.initials: DY
authors.lastname: Zeng
authors.forename: Ji-lin
authors.initials: JL
authors.lastname: Chen
authors.forename: Xue-wen
authors.initials: XW
authors.lastname: Qin
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.forename: Chang-hui
authors.initials: CH
authors.lastname: DU
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D015912:Thrombolytic Therapy
chemical_list: D005343:Fibrinolytic Agents