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RESCUE PERCUTANEOUS CORONARY INTERVENTION: DOES THE CONCEPT MAKE SENSE?
  1. Eric Eeckhout
  1. Correspondence to:
    Professor Eric Eeckhout
    Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; eric.eeckhout{at}chuv.ch

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Rescue percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) is defined as mechanical reperfusion for failed fibrinolysis. The efficacy of rescue PCI has always been debated. Despite a high level of immediate technical success and the positive impact on ventricular function, conflicting data on mortality have been reported. Several historical explanations may be given. Initially, rescue PCI was associated with a high reocclusion rate and increased mortality if unsuccessful. Contrary to fibrinolysis, the rare randomised trials on rescue PCI are characterised by small study populations and major differences in methodology. In particular, there is no consensus on timing and defining failed fibrinolysis. During the last few years two randomised trials, both from the UK, have been published, providing new insights into this old problem. It is now apparent that rescue PCI is superior to conservative management or pharmacotherapy. Efforts should be made to implement this treatment in patients who fail fibrinolysis.

HISTORICAL BACKGROUND

STEMI is a dramatic clinical condition and a major healthcare problem. However, changes in the management of STEMI over the past two decades are a perfect illustration of how progress in medicine has the potential to improve prognosis. Not until the early 1980s, following the publication of the pioneering paper by De Wood et al on coronary thrombosis, was the principle of reperfusion recognised and accepted as the rule.1 Consequently, fibrinolytic therapy became the treatment of choice. At present, this treatment is still widely applied and supported by a large body of scientific evidence. Fibrinolysis is especially effective within 2 h of symptom onset and is still the primary treatment in rural areas without a “network of referral for mechanical reperfusion”. Percutaneous reperfusion (referred to as primary PCI), introduced more than 15 years ago, has nowadays become the preferred strategy, particularly as its benefit extends beyond …

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