Rescue angioplasty for failed fibrinolysis--long-term follow-up of a large cohort.
BACKGROUND
Fibrinolysis remains an important treatment for ST-elevation myocardial infarction, but fails to achieve adequate reperfusion in a significant proportion of cases. "Rescue" angioplasty is seen as the preferred treatment strategy in most contemporary centers although the literature provides conflicting evidence.


METHODS
We retrospectively reviewed all cases of rescue angioplasty performed at our cardiothoracic center from July 1999 to June 2008. The diagnosis of failed lysis was made on the basis of an ECG demonstrating failure of ST segment resolution >50% at 90 min. Periprocedural data was taken from a dedicated procedural database and mortality data obtained from the UK Office of National Statistics.


RESULTS
A total of 316 cases were performed. Patients were aged 61 ± 11 years. Thirty-day mortality was 8.9%. Thirty-day mortality in those presenting with cardiogenic shock was 50%, and in those requiring blood transfusion was also 50%. Thirty day mortality in those with TIMI III flow at the end of the procedure was significantly less than in those in whom this was not the case (6.6% vs. 23.3%; P < 0.001). One year mortality for the entire cohort was 10.1%. Longer-term follow-up revealed after 5.2 ± 2.3 years, survival in this cohort was 83%. Significant bleeding requiring blood transfusion occurred in 2.5% of cases.


CONCLUSIONS
We have shown that rescue angioplasty can be performed with good procedural success rates and excellent long-term results. Limiting bleeding complications and achieving TIMI III flow appear to be major determinants of achieving good long term results.
Sohal
Manav
M
Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton and Sussex, UK.
Foo
Fred
F
Sirker
Alex
A
Rajani
Ronak
R
Khawaja
Muhammed Z
MZ
Pegge
Nicholas
N
Hatrick
Robert
R
Kneale
Barry
B
Signy
Mark
M
Holmberg
Stephen
S
de Belder
Adam
A
Hildick-Smith
David
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D001803:Blood Transfusion; D003326:Coronary Circulation; D004562:Electrocardiography; D004739:England; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016879:Salvage Therapy; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D017211:Treatment Failure