Premium
Rescue angioplasty after failed fibrinolysis foracute myocardial infarction: Predictors of a failed procedure and 1‐year mortality
Author(s) -
Kunadian Babu,
Vijayalakshmi Kunadian,
Dunning Joel,
Sutton Andrew GC,
Muir Douglas F,
Wright Robert A,
Hall James A,
de Belder Mark A
Publication year - 2008
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.21273
Subject(s) - medicine , cardiogenic shock , fibrinolysis , cardiology , myocardial infarction , timi , shock (circulatory) , thrombolysis
Background: Rescue angioplasty (rPCI) for failed fibrinolysis is associated with a low mortality if successful, but a high mortality if it fails. The latter may reflect a high‐risk group or harm in some patients. Predictors of success or failure of rPCI may aid selection of patients to be treated. Methods: Unselected patients referred for rPCI from March 1994 to March 2005 were studied to determine the predictors of a failed procedure and 1‐year mortality. Results: Of 440 patients undergoing emergency coronary angiography for failed fibrinolysis (1‐year mortality 18%), 101 had thrombolysis in myocardial infarction flow grade (TFG) 3 in the infarct‐related vessel. rPCI was attempted in 318 of 339 patients with 75 years, shock, and final TFG < 3 were independent predictors of 1‐year mortality. Conclusions: Cardiogenic shock is an independent predictor of a failed rPCI. Age group >75 years and shock were the only independent clinical predictors of 1‐year mortality. These clinical variables may help in selecting patients for either a strategy of rescue angioplasty after failed fibrinolysis, or in selecting specific patients who might do better with a policy of primary angioplasty. © 2008 Wiley‐Liss, Inc.