Author/Authors :
Lech Poloimageski، نويسنده , , Mariusz Gimagesior، نويسنده , , Jarosimageaw Wasilewski، نويسنده , , Krzysztof Wilczek، نويسنده , , Andrzej Wnimagek، نويسنده , , E. limagebieta Adamowicz-Czoch MD، نويسنده , , Jacek Sikora، نويسنده , , Andrzej Lekston، نويسنده , , Tadeusz Zimagebik، نويسنده , , Marek Gierlotka، نويسنده , , Rafaimage Wojnar، نويسنده , , Janusz Szkodziimageski، نويسنده , , Marek Kondys، نويسنده , , B. oimageena Szyguimagea-Jurkiewicz، نويسنده , , Robert Woimagek، نويسنده , , Marian Zembala، نويسنده ,
Abstract :
Background
In patients with acute myocardial infarction (MI), the efficacy of thrombolysis is low. Angioplasty after failed thrombolysis (rescue percutaneous coronary angioplasty [PTCA]) has been associated with an increase in the incidence of inhospital complications. It has been proposed that these complications result from the procedure itself. Thus, the aim of this study was to compare the efficacy, inhospital complications, and mortality rate of patients with MI who are treated with primary PTCA and PTCA after initial thrombolysis (rescue or immediate rescue) in an experienced clinical center specializing in percutaneous coronary interventions.
Methods and results
The study group consisted of consecutive patients with MI treated with primary PTCA (n = 195) or PTCA after initial thrombolysis (n = 179). The study was performed in a referral center with a 24-hour catheter-laboratory service. The success rate of the procedure was 90.5% and 88.2% in the PTCA after initial thrombolysis group and primary PTCA group, respectively. The groups did not differ in the frequency of reocclusion, emergency surgical revascularization (coronary artery bypass grafting), or stroke. In patients without cardiogenic shock, the inhospital mortality rates were 3.2% and 0.6% in the rescue and immediate rescue group and primary PTCA group, respectively (not significant). In a subgroup of patients with cardiogenic shock, the mortality rate was 36.0% in the initial thrombolysis PTCA group and 30.8% in the primary PTCA group. However, after successful PTCA in this subgroup, the mortality rate dropped to 18% and 10%, respectively.
Conclusions
After initial thrombolysis, PTCA is safe, effective, and likely to restore grade 3 Thrombolysis In Myocardial Infarction flow in about 90% of patients. When available, immediate rescue PTCA should be performed in all patients, including patients with cardiogenic shock.
