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Rescue Angioplasty or Repeat Fibrinolysis After Failed Fibrinolytic Therapy for ST-Segment Myocardial Infarction

A Meta-Analysis of Randomized Trials

Harindra C. Wijeysundera, MD^_*, Ram Vijayaraghavan, MD^_*, Brahmajee K. Nallamothu, MD, MPH, JoAnne M. Foody, MD^,, Harlan M. Krumholz, MD, SM^,||, Christopher O. Phillips, MD, MPH^¶, Amir Kashani, MD, MS, John J. You, MD^#,, Jack V. Tu, MD, PhD^_**, and Dennis T. Ko, MD, MSc^_*,,_*

^_* Division of Cardiology, Schulich Heart Centre and Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Health Services and Research Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, Michigan
Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
West Haven Veterans Administration Medical Center, West Haven, Connecticut
^|| Section of Health Policy and Administration, Department of Epidemiology and Public Health; Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine; and the Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Connecticut
^¶ The Cleveland Clinic Foundation, Cleveland, Ohio
^# Department of General Internal Medicine, University Health Network, Ontario, Canada
^_** Department of Medicine, Sunnybrook Health Sciences Centre, Ontario, Canada
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada

View larger version (27K): [in this window] [in a new window] [Download PPT slide]   Figure 1 Process of Study Selection for Rescue PCI or Repeat Fibrinolytic Therapy Versus Conservative Management PCI = percutaneous coronary intervention.

View larger version (21K): [in this window] [in a new window] [Download PPT slide]   Figure 2 Efficacy End Points for Rescue PCI Versus Conservative Therapy CI = confidence interval; MERLIN = Middlesbrough Early Revascularization to Limit Infarction trial; NNT = number needed to treat; PCI = percutaneous coronary intervention; REACT = Rescue Angioplasty versus Conservative Treatment or Repeat Thrombolysis trial; RESCUE = Randomized Comparison of Rescue Angioplasty with Conservative Management of Patients with Early Failure of Thrombolysis for Acute Anterior Myocardial Infarction trial; RR = relative risk; TAMI = Thrombolysis and Angioplasty in Myocardial Infarction study.

View larger version (13K): [in this window] [in a new window] [Download PPT slide]   Figure 3 Safety End Points for Rescue PCI Versus Conservative Therapy NNH = number needed to harm. Other abbreviations as in Figure 2.

View larger version (21K): [in this window] [in a new window] [Download PPT slide]   Figure 4 Efficacy End Points for Repeat Fibrinolytic Therapy Versus Conservative Therapy Abbreviations as in Figure 2.

View larger version (13K): [in this window] [in a new window] [Download PPT slide]   Figure 5 Safety End Points for Repeat Fibrinolytic Therapy Versus Conservative Therapy Abbreviations as in Figure 2.