Emergency 'rescue' percutaneous transluminal coronary angioplasty after failed thrombolysis with streptokinase. Early and late results

D. R. Holmes, B. J. Gersh, K. R. Bailey, G. S. Reeder, J. F. Bresnahan, D. R. Bresnahan, R. E. Vlietstra

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Although thrombolytic therapy has been a major advance in the treatment of acute myocardial infarction, in at least 25% of patients the artery remains occluded after administration. In these patients, the strategy of 'rescue' or 'salvage' angioplasty is frequently used although follow-up data are limited. Sixty-three patients underwent percutaneous transluminal coronary angioplasty (PTCA) after thrombolytic therapy for acute myocardial infarction. The decision to proceed with PTCA was based on physician preference and not a specific research protocol. In 34 of these selected patients, PTCA was performed as a rescue procedure because the infarct-related artery remained occluded (group 1); in 29 of these patients, it was performed to treat a severe but subtotal residual stenosis (group 2). PTCA successfully restored patency in 71% of group 1 and in 90% of group 2. Group 1 patients had a significantly worse baseline ejection fraction than did those in group 2 (47 ± 13% vs. 58 ± 13%, p = 0.0015). Group 1 patients also had a significantly worse predismissal ejection fraction (36 ± 13% vs. 50 ± 14%, p = 0.00004). During initial hospitalization, 14 (22%) patients underwent coronary bypass surgery. In-hospital mortality was low in each group (3% in group 1 and 0% in group 2). During a mean follow-up of 4 years, 89% of group 1 patients remained alive as compared with 97% of group 2 patients. This excellent 4-year survival rate, despite the depressed predismissal ejection fraction in patients undergoing rescue PTCA, raises the issue of whether acute reperfusion has a beneficial effect aside from any impact on myocardial salvage and preservation of left ventricular function.

Original languageEnglish (US)
Pages (from-to)IV-51-IV-56
JournalCirculation
Volume81
Issue number3 SUPPL.
StatePublished - Jan 1 1990

Keywords

  • 'Rescue' PTCA
  • Emergency PTCA
  • Myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Holmes, D. R., Gersh, B. J., Bailey, K. R., Reeder, G. S., Bresnahan, J. F., Bresnahan, D. R., & Vlietstra, R. E. (1990). Emergency 'rescue' percutaneous transluminal coronary angioplasty after failed thrombolysis with streptokinase. Early and late results. Circulation, 81(3 SUPPL.), IV-51-IV-56.