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A randomized trial of rescue angioplasty versus a conservative approach for failed fibrinolysis in ST-segment elevation myocardial infarction

The Middlesbrough Early Revascularization to Limit INfarction (MERLIN) trial

Andrew G. C. Sutton, MA, MB, MRCP^*, Philip G. Campbell, MB, MRCP^*, Richard Graham, MB, MRCP^*, Dallas J. A. Price, MB, MRCP^*, Janine C. Gray, BSc(Hons), PhD, Ever D. Grech, MD, MRCP, FACC^*, James A. Hall, MA, MD, FRCP^*, Alun A. Harcombe, MD, MRCP^*, Robert A. Wright, MD, FRCP^*, Roger H. Smith, BSc(Hons), MB, FRCP, Jerry J. Murphy, MB, BS, DM, FRCP, Ananthaiah Shyam-Sundar, MB, BS, MD, DM, FRCP, Michael J. Stewart, MD, FRCP^*, Adrian Davies, BSc, MB, BS, FRCP^*, Nicholas J. Linker, BSc, MD, FRCP, FESC^* and Mark A. de Belder, MA, MD, FRCP^*,*

^* The James Cook University Hospital, Middlesbrough, UK
University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, UK
University Hospital of North Tees, Stockton-on-Tees, UK
Darlington Memorial Hospital, Darlington, United Kingdom

View larger version (18K): [in a new window]   Figure 1 Rescue angioplasty patients, showing catheterization laboratory findings and outcomes. "Success" was defined by patent infarct-related vessel (Thrombolysis In Myocardial Infarction [TIMI] flow grade 2 or 3), no emergency coronary artery bypass graft, and survival during the procedure. Unsched revasc = subsequent revascularization; CCF = congestive cardiac failure; IRV = infarct-related vessel; PCI = percutaneous coronary intervention.

View larger version (8K): [in a new window]   Figure 2 Thirty-day Kaplan-Meier survival curve. Dotted line = conservative arm; solid line = rescue angioplasty arm.

View larger version (9K): [in a new window]   Figure 3 Thirty-day Kaplan-Meier event-free survival curve. Dotted line = conservative arm; solid line = rescue angioplasty arm.

View larger version (12K): [in a new window]   Figure 4 Thirty-day mortality according to ST-segment reduction 6 h after initiation of fibrinolytic therapy. PCI = percutaneous coronary intervention.