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- IABP, intra-aortic balloon pump
- MERLIN, Middlesbrough Early Revascularization to Limit Infarction
- PCI, percutaneous coronary intervention
- REACT, Rescue Angioplasty versus Conservative management of Thrombolysis
- TIMI, Thrombolysis In Myocardial Infarction
Intravenous thrombolysis remains the preferred treatment for many patients presenting with ST elevation myocardial infarction. Reperfusion fails in 30–50% of patients, which is associated with an adverse prognosis. For these patients with reperfusion failure, rescue percutaneous coronary intervention (PCI) can be used, but major access site bleeding is a risk with the femoral approach. Transradial PCI has been shown to reduce access site complications in stable patients and may therefore offer a solution to the access site complications associated with rescue PCI.1 We assessed the value of this approach in 105 consecutive patients treated with transradial rescue PCI for failed thrombolysis.
Transradial programs for PCI began at the University Hospital of North Staffordshire in September 1998 and at the Sussex Cardiac Centre in December 2001. Patients presenting with a large myocardial infarction within 12 h of the onset of chest pain and evidence of failed reperfusion have routinely been treated with rescue PCI by two experienced radial operators (JN, DHS). Failure to reperfuse was diagnosed by the presence of persistent ST segment elevation at 90 min after thrombolysis. Transradial PCI was performed as previously described.1 Patients received 5000–10 000 U of intravenous heparin at the start of the procedure. Clopidogrel was given to patients after successful stent implantation and all patients received aspirin …