Heart 2000;84:197-204 ( August )

Interventional cardiology surgery

Failure of thrombolysis: experience with a policy of early angiography and rescue angioplasty for electrocardiographic evidence of failed thrombolysis A G C Sutton, P G Campbell, E D Grech, D J A Price, A Davies, J A Hall, M J Stewart, M A de Belder

Cardiothoracic Division, South Cleveland Hospital, Marton Road, Middlesbrough TS4 3BW, UK

Correspondence to: Dr de Belder email: mdb.sch.heart{at}onyxnet.co.uk

Accepted 24 May 2000

OBJECTIVETo assess the outcome of a policy of emergency coronary angiography with or without rescue angioplasty in patients with acute myocardial infarction and ECG evidence of failed reperfusion after thrombolysis.
DESIGNA cohort study.
SETTINGRegional cardiothoracic unit.
PATIENTS197 patients with acute myocardial infarction fulfilling a simple ECG criterion of failed reperfusion.
INTERVENTIONSEmergency coronary angiography proceeding to rescue angioplasty for inadequate antegrade flow.
MAIN OUTCOME MEASURESHospital mortality for all 197 patients; incidence of successful and failed rescue angioplasty; need for additional revascularisation in those receiving rescue angioplasty compared with those not treated in this way.
RESULTS197 patients had emergency angiography for ECG evidence of failed reperfusion; 156 patients received immediate rescue angioplasty. Overall hospital mortality for those undergoing rescue angioplasty was 11.5%. Rescue angioplasty achieved TIMI 2 (11) or TIMI 3 (124) in 135 patients, who had a hospital mortality of 5.9%. Failure to achieve at least TIMI 2 flow following rescue angioplasty occurred in 21 patients, with a hospital mortality of 48%. In the 41 patients in whom immediate rescue angioplasty was not performed, reinfarction or requirement for revascularisation occurred in 37%. Reinfarction occurred in three patients (1.9%) who had immediate rescue angioplasty. Hospital mortality for the whole cohort was 10.7%.
CONCLUSIONSA policy of emergency coronary angiography proceeding to rescue angioplasty where appropriate reduces mortality in a high risk group to a level less than expected for patients with acute myocardial infarction and ECG evidence of failed reperfusion. Unsuccessful rescue angioplasty is associated with a high mortality.


Keywords: acute myocardial infarction; rescue angioplasty; failed reperfusion

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© 2000 by Heart
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