title: Safety and efficacy of rescue angioplasty for ST-elevation myocardial infarction with high utilization rates of glycoprotein IIb/IIIa inhibitors.
abstract: BACKGROUND
  Fibrinolytic therapies remain widely used for ST-elevation myocardial infarction, and for "failed reperfusion," rescue percutaneous coronary intervention (PCI) is guideline recommended to improve outcomes. However, these recommendations are based on data from an earlier era of pharmacotherapy and procedural techniques.
  
  
  RESULTS
  To determine factors affecting prognosis after rescue PCI, we studied 241 consecutive patients (median age 55 years, interquartile range [IQR] 48-65) undergoing procedures between 2001 and 2009 (53% anterior ST-elevation myocardial infarction and 78% transferred). The median treatment-related times were 1.2 hours (IQR 0.8-2.2) from symptom onset to door, 2 hours (IQR 1.3-3.2) from symptom onset to fibrinolysis (93% tenecteplase), and 3.9 hours (IQR 3.1-5.2) from fibrinolysis to balloon. Procedural characteristics were stent deployment in 95% (11.6% drug eluting) and 78% glycoprotein IIb/IIIa inhibitor use, and Thrombolysis In Myocardial Infarction (TIMI) 3 flow rates pre-PCI and post-PCI were 41% and 91%, respectively (P < .001). At 30 days, TIMI major bleeding occurred in 16 (6.6%) patients, and 23 (9.5%) patients received transfusions; nonfatal stroke occurred in 4 (1.7%) patients (2 hemorrhagic). Predictors of TIMI major bleeding were female gender (odds ratio 3.194, 95% CI 1.063-9.597; P = .039) and pre-PCI shock (odds ratio 3.619, 95% CI,1.073-12.207; P = .038). Mortality at 30 days was 6.2%, and 3.2% in patients without pre-PCI shock. One-year mortality was 8.2% (5.3% in patients without pre-PCI cardiogenic shock), 5.2% had reinfarction, and the target vessel revascularization rate was 6.4% (2.6% in arteries ≥ 3.5 mm in diameter). Pre-PCI shock, female gender, and post-PCI TIMI flow grades ≤ 2 were significant predictors of 1-year mortality on multivariable regression modeling, but TIMI major bleeding was not.
  
  
  CONCLUSIONS
  Rescue PCI with contemporary treatments can achieve mortality rates similar to rates for contemporary primary PCI in patients without pre-PCI shock. Whether rates of bleeding can be reduced by different pharmacotherapies and interventional techniques needs clarification in future studies.
authors.affiliation: Department of Cardiology, Liverpool Hospital, South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Ibrahim M
authors.initials: IM
authors.lastname: Shugman
authors.forename: Victar
authors.initials: V
authors.lastname: Hsieh
authors.forename: Samuel
authors.initials: S
authors.lastname: Cheng
authors.forename: Devang
authors.initials: D
authors.lastname: Parikh
authors.forename: Daniel
authors.initials: D
authors.lastname: Tobing
authors.forename: Noemi
authors.initials: N
authors.lastname: Wouters
authors.forename: Rozemarijn
authors.initials: R
authors.lastname: van der Vijver
authors.forename: Queenie
authors.initials: Q
authors.lastname: Lo
authors.forename: Rohan
authors.initials: R
authors.lastname: Rajaratnam
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Hopkins
authors.forename: Sidney
authors.initials: S
authors.lastname: Lo
authors.forename: Dominic
authors.initials: D
authors.lastname: Leung
authors.forename: Craig P
authors.initials: CP
authors.lastname: Juergens
authors.forename: John K
authors.initials: JK
authors.lastname: French
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use*; D015912:Thrombolytic Therapy
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex