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ISCHAEMIC HEART DISEASE
Although primary percutaneous coronary intervention (PCI) is a proven therapeutic approach in ST elevation myocardial infarction (STEMI) and is used increasingly, intravenous thrombolysis remains the first line treatment in 30–70% of cases worldwide. However, thrombolysis results in a grade 3 flow, according to the thrombolysis in myocardial infarction (TIMI) classification system, in only 60% of patients, even with current fibrin specific agents. To date, it has been unclear how best to treat the remaining patients, in whom thrombolysis has not worked. In a randomised trial involving 427 patients with STEMI of < 6 hours’ duration treated with thrombolysis, in whom reperfusion failed to occur (< 50% ST segment resolution) within 90 minutes, patients were randomly assigned to repeated thrombolysis (142 patients), conservative treatment (141 patients), or rescue PCI (144 patients). The primary end point was a composite of death, reinfarction, stroke, or severe heart failure within six months. The rate
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