Rescue Angioplasty: Characteristics and Results in a Single-Center Experience

• Published in: Journal of interventional cardiology Vol. 24; no. 1; pp. 42 - 48
• Main Authors: PÉREZ-BERBEL, PATRICIO, VALENCIA, JOSÉ, RUIZ-NODAR, JUAN MIGUEL, PINEDA, JAVIER, BORDES, PASCUAL, MAINAR, VICENTE, SOGORB, FRANCISCO
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.02.2011
• Subjects: Aged; Angioplasty, Balloon; Antibodies, Monoclonal - therapeutic use; Coronary Angiography; Drug-Eluting Stents; Female; Fibrinolytic Agents - therapeutic use; Health Status Indicators; Humans; Immunoglobulin Fab Fragments - therapeutic use; Male; Middle Aged; Myocardial Infarction - drug therapy; Myocardial Infarction - therapy; Platelet Aggregation Inhibitors - therapeutic use; Prognosis; Prospective Studies; Registries; Spain; Treatment Failure; Spain
• ISSN: 0896-4327; 1540-8183
• DOI: 10.1111/j.1540-8183.2010.00595.x

Purpose and Methods:  Rescue angioplasty (RA) has demonstrated its efficacy for the treatment of failed thrombolysis after acute myocardial infarction (AMI). We analyzed clinical, angiographic, and procedural characteristics, and prognosis at 30 days of prospective cohort of unselected patients admitted for RA. Results:  From August 2004 to August 2009, 361 patients were included in a single center. The median time pain to the thrombolysis was 140 minutes (interquartile range [IQR] 90–210), delay transfer 100 minutes (IQR 65–120); pain to PCI was 330 minutes (IQR 270–400). Initial flow TIMI 3 (Thrombolysis in Myocardial Infarction) was presented in 102 (28.3%) of cases and blush grade 3 in 88 (24.4%). After the procedure, TIMI 3 flow was achieved in 286 (79.2%) and blush grade 3 in 256 (71%) (P < 0.001 and P < 0,001, respectively). A glycoprotein IIb/IIIa receptor inhibitor (Abciximab) was used in 115 patients (32%). Stents were implanted in 339 (94%) of patients, 137 (38%) of which were drug‐eluting stent. Complete ST segment resolution was observed in 202 (64.5%) patients in 12‐lead electrocardiogram (ECG) and procedural success was 77.6%. Adverse cardiac events and death after 30 days follow‐up were 13.6% and 10.7%, respectively. Target vessel revascularization at 30 days was 1.9%. Conclusions:  Routine application of RA in patients with persistent ST elevation 90 minutes after thrombolysis is a useful technique for achieving revascularization of the affected artery. In‐hospital mortality remains high especially in patients with cardiac shock, despite new interventional techniques available, and adjunctive antithrombotic therapy. (J Interven Cardiol 2011;24:42–48)