Rescue Angioplasty after Failed Thrombolytic Therapy for Acute Myocardial Infarction

Early and long term outcome of rescue percutaneous coronary intervention (R-PCI): experience from a tertiary care center in Pakistan

“…146 min [12,21]. The minimum time delay from pain to rescue PCI has been [4 h in most of the trials hence supporting the net clinical benefit of late restoration of flow in IRA [20].…”

“…The most recent American College of Cardiology/American Heart Association guidelines for management of patients with STsegment elevation MI (STEMI) define rescue PCI as ''PCI within 12 h after failed fibrinolysis for patients with continuing or recurrent myocardial ischemia'' [11]. Recently the REACT trial showed that rescue PCI reduced a composite endpoint of death, recurrent MI, cerebrovascular events and severe heart failure in patients with failed thrombolysis when compared to either repeat fibrinolysis or conservative approach [12]. Whereas the efficacy of Rescue PCI for failed thrombolysis has been established, most of the evidence comes from western literature, with essentially no data on the feasibility, applicability, success and outcomes in third world nations, particularly the IndoPakistan region, home to 1/6th of the world's population.…”

Percutaneous coronary intervention in ST-segment elevation myocardial infarction

“…The recent development of improved techniques, including the use of stents, has lead to renewed interest in the effectiveness of rescue PCI. The Randomized Evaluation of Assertive Community Treatment in North London (REACT) study, the largest of several randomized controlled trials comparing rescue PCI, repeated fibrinolysis, and conservative treatment, reported that the adjusted hazard ratio of the occurrence of the primary end point (a composite of death, reinfarction, stroke, or congestive heart failure) was significantly lower for rescue PCI than for repeated fibrinolysis or conservative treatment, with no large difference in bleeding complications [28]. These results suggest that rescue PCI should be performed in patients with no distinct evidence of successful reperfusion by about 90 min after thrombolytic therapy, particularly in those who have large myocardial areas at risk or a low risk of bleeding.…”

Reperfusion options in ST-elevation myocardial infarction patients with expected delays

“…The REACT trial was a multicenter, randomized trial involving 427 STEMI patients from the United Kingdom who failed reperfusion after fi brinolysis and were randomized to repeat fi brinolysis, conservative therapy, or rescue PPCI [ 26 ] with a primary end point of a composite of death, reinfarction, stroke, or severe heart failure at 6 months. Event-free survival was 84.6% with rescue PPCI, 70.1% with conservative therapy, and 68.7% with repeat fi brinolysis ( P = 0.0004).…”