Fate of patients with acute myocardial infarction with patency of the infarct-related vessel achieved with successful thrombolysis versus rescue angioplasty

Christ Hospital, Cincinnati, Ohio 45219.

Patients with failure of infarct-related artery recanalization after thrombolytic therapy have a poor clinical outcome. These patients have been considered for rescue angioplasty 90 min after thrombolytic therapy at the time of emergency catheterization in the course of five Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) trials. The outcome of 776 patients with patent infarct-related vessels after emergency catheterization was analyzed--607 with thrombolysis-mediated patency of the infarct-related vessel and 169 with patency achieved by angioplasty. Baseline characteristics of the thrombolysis and angioplasty patency groups were similar except for a higher acute left ventricular ejection fraction (51.3% versus 48.2%) in the thrombolysis group (p = 0.003). Seven to 10 day left ventricular ejection fraction was higher (52.3% versus 48.1%), infarct zone functional recovery was greater (0.44 versus 0.21 standard deviation/chord, or 18% versus 7%, p = 0.001) and reocclusion was less (11% versus 21%) in the thrombolysis compared with the angioplasty group. Despite these differences, angioplasty patency was associated with the same low in-hospital mortality rate (5.9% versus 4.6%) and long-term mortality rate (3% versus 2%) as thrombolysis patency. Reocclusion adversely affected the mortality rate and ventricular functional recovery. Technical failure of rescue angioplasty was associated with a much higher mortality rate than was technical success (39.1% versus 5.9%). Thrombolysis patency was preferable to angioplasty patency after thrombolytic therapy in acute myocardial infarction, but both were associated with the same low in-hospital and long-term mortality rates, suggesting that rescue angioplasty is beneficial in some patients with failure of infarct-related artery recanalization after thrombolytic therapy.

This article has been cited by other articles:

				T. P. Wharton Jr, E. C. Keeley, C. L. Grines, T. P. Wharton Jr, E. C. Keeley, and C. L. Grines The Case for Community Hospital Angioplasty Circulation, November 29, 2005; 112(22): 3509 - 3534. [Full Text] [PDF]

				P. G. Steg, L. Francois, B. Iung, D. Himbert, P. Aubry, P. Charlier, H. Benamer, L. J. Feldman, and J.-M. Juliard Long-term clinical outcomes after rescue angioplasty are not different from those of successful thrombolysis for acute myocardial infarction Eur. Heart J., September 2, 2005; 26(18): 1831 - 1837. [Abstract] [Full Text] [PDF]

				A. Schomig, G. Ndrepepa, J. Mehilli, J. Dirschinger, S. G. Nekolla, C. Schmitt, S. Martinoff, M. Seyfarth, M. Schwaiger, A. Kastrati, et al. A randomized trial of coronary stenting versus balloon angioplasty as a rescue intervention after failed thrombolysis in patients with acute myocardial infarction J. Am. Coll. Cardiol., November 16, 2004; 44(10): 2073 - 2079. [Abstract] [Full Text] [PDF]

				C. L. Grines and W. W. O'Neill Rescue angioplasty: Does the concept need to be rescued? J. Am. Coll. Cardiol., July 21, 2004; 44(2): 297 - 299. [Full Text] [PDF]

				E. Ronner, R.T. van Domburg, M.J.B.M. van den Brand, P.J. de Feyter, D.P. Foley, W.J. van der Giessen, P.W. Serruys, and M.L. Simoons Platelet GP IIb/IIIa receptor blockers for failed thrombolysis in acute myocardial infarction, alone or as adjunct to other rescue therapies. A single centre retrospective analysis of 548 consecutive patients with acute myocardial infarction Eur. Heart J., October 1, 2002; 23(19): 1529 - 1537. [Abstract] [Full Text] [PDF]

				K P Balachandran, J Miller, A C H Pell, B D Vallance, and K G Oldroyd Rescue percutaneous coronary intervention for failed thrombolysis: results from a district general hospital Postgrad. Med. J., June 1, 2002; 78(920): 330 - 334. [Abstract] [Full Text] [PDF]

				J. A. de Lemos and E. Braunwald ST segment resolution as a tool for assessing the efficacy of reperfusion therapy J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1283 - 1294. [Abstract] [Full Text] [PDF]

				T Pohl, P Hochstrasser, M Billinger, M Fleisch, B Meier, and C Seiler Influence on collateral flow of recanalising chronic total coronary occlusions: a case-control study Heart, October 1, 2001; 86(4): 438 - 443. [Abstract] [Full Text] [PDF]

				U. Kaul, R. Sapra, B. Singh, D. Sudan, T. Ghose, N. S. Dixit, and H. S. Wasir Abciximab During Rescue Angioplasty After Failed Thrombolysis Asian Cardiovasc Thorac Ann, March 1, 2001; 9(1): 31 - 35. [Abstract] [Full Text] [PDF]

				L. E. Goldman and M. J. Eisenberg Identification and Management of Patients with Failed Thrombolysis after Acute Myocardial Infarction Ann Intern Med, April 4, 2000; 132(7): 556 - 565. [Abstract] [Full Text] [PDF]

				A. M. Ross, K. S. Coyne, J. S. Reiner, S. W. Greenhouse, C. Fink, A. Frey, E. Moreyra, M. Traboulsi, N. Racine, A. L. Riba, et al. A randomized trial comparing primary angioplasty with a strategy of short-acting thrombolysis and immediate planned rescue angioplasty in acute myocardial infarction: the PACT trial J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1954 - 1962. [Abstract] [Full Text] [PDF]

				F Vermeer, A J M O. Ophuis, E J v. Berg, L G Brunninkhuis, C J Werter, A G Boehmer, A H Lousberg, W R Dassen, and F W Bar Prospective randomised comparison between thrombolysis, rescue PTCA, and primary PTCA in patients with extensive myocardial infarction admitted to a hospital without PTCA facilities: a safety and feasibility study Heart, October 1, 1999; 82(4): 426 - 431. [Abstract] [Full Text] [PDF]

				A. Brodison, R. S More, and A. Chauhan Stents in medicine: The role of coronary angioplasty and stenting in acute myocardial infarction Postgrad. Med. J., October 1, 1999; 75(888): 591 - 598. [Abstract] [Full Text]

				T. H. Marwick, R. Brunken, N. Meland, E. Brochet, F. M. Baer, T. Binder, F. Flachskampf, O. Kamp, C. Nienaber, P. Nihoyannopoulos, et al. Accuracy and feasibility of contrast echocardiography for detection of perfusion defects in routine practice: Comparison with wall motion and Technetium-99m sestamibi single-photon emission computed tomography J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1260 - 1269. [Abstract] [Full Text] [PDF]

				J. S. Hochman, J. Boland, L. A. Sleeper, M. Porway, J. Brinker, J. Col, A. Jacobs, J. Slater, D. Miller, H. Wasserman, et al. Current Spectrum of Cardiogenic Shock and Effect of Early Revascularization on Mortality : Results of an International Registry Circulation, February 1, 1995; 91(3): 873 - 881. [Abstract] [Full Text]

				H. Tomoda Electrocardiographic Prediction of the Success of Coronary Reperfusion by Intravenous Thrombolytic Therapy: An Experimental Study Angiology, August 1, 1992; 43(8): 631 - 640. [Abstract] [PDF]