Objectives The goal of this study was to evaluate the safety and feasibility of early angioplasty within 12 hours and selective angioplasty 1 week later after successful thrombolysis in acute ST segment elevation myocardial infarction.
Methods A total of 224 patients with acute ST segment elevation myocardial infarction received thrombolysis with reteplase were randomly assigned to early PCI (E-PCI) group or selective PCI (S-PCI) group. Patients assigned to the E-PCI group received interventional procedure within 12 hours after randomisation, and patients assigned to the S-PCI group received interventional procedure 1 week later after randomisation. The primary end point was a combined end points consisting of death, reinfarction, recurrent ischaemia, congestive heart failure during hospitalisation. The secondary end points included death, reinfarction, recurrent ischaemia and repeat PCI during 12 months follow up.
Results The baseline clinical characteristics were well balanced between the two groups. The primary end point rate was significantly higher in the S-PCI group compared with the E-PCI group (14.3% vs. 4.5%, p = 0.0219). Fewer episodes of recurrent ischaemia were seen in the E-PCI group compared with the S-PCI group during hospital stay (0.0% vs. 6.3%, p = 0.0212). There were no significant differences in death, reinfarction, recurrent ischaemia and repeat PCI between two groups during 12 months follow up.
Conclusions Patients presenting with a ST-segment elevation myocardial infarction who could not undergo timely primary PCI, thrombolysis and followed by PCI within 12 hours was a preferred reperfusion strategy and associated with a significant reduction of the recurrent ischaemia during hospitalisation.
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