Rescue angioplasty after failed fibrinolysis foracute myocardial infarction: Predictors of a failed procedure and 1‐year mortality

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.