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Rescue angioplasty for failed fibrinolysis—Long‐term follow‐up of a large cohort
Author(s) -
Sohal Manav,
Foo Fred,
Sirker Alex,
Rajani Ronak,
Khawaja Muhammed Z.,
Pegge Nicholas,
Hatrick Robert,
Kneale Barry,
Signy Mark,
Holmberg Stephen,
de Belder Adam,
HildickSmith David
Publication year - 2010
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.22771
Subject(s) - medicine , timi , cardiogenic shock , angioplasty , fibrinolysis , myocardial infarction , cohort , thrombolysis , mortality rate , retrospective cohort study , surgery , cardiology
Background: Fibrinolysis remains an important treatment for ST‐elevation myocardial infarction, but fails to achieve adequate reperfusion in a significant proportion of cases. “Rescue” angioplasty is seen as the preferred treatment strategy in most contemporary centers although the literature provides conflicting evidence. Methods: We retrospectively reviewed all cases of rescue angioplasty performed at our cardiothoracic center from July 1999 to June 2008. The diagnosis of failed lysis was made on the basis of an ECG demonstrating failure of ST segment resolution >50% at 90 min. Periprocedural data was taken from a dedicated procedural database and mortality data obtained from the UK Office of National Statistics. Results: A total of 316 cases were performed. Patients were aged 61 ± 11 years. Thirty‐day mortality was 8.9%. Thirty‐day mortality in those presenting with cardiogenic shock was 50%, and in those requiring blood transfusion was also 50%. Thirty day mortality in those with TIMI III flow at the end of the procedure was significantly less than in those in whom this was not the case (6.6% vs. 23.3%; P < 0.001). One year mortality for the entire cohort was 10.1%. Longer‐term follow‐up revealed after 5.2 ± 2.3 years, survival in this cohort was 83%. Significant bleeding requiring blood transfusion occurred in 2.5% of cases. Conclusions: We have shown that rescue angioplasty can be performed with good procedural success rates and excellent long‐term results. Limiting bleeding complications and achieving TIMI III flow appear to be major determinants of achieving good long term results. © 2010 Wiley‐Liss, Inc.