A matched comparison of the combination of prehospital thrombolysis and standby rescue angioplasty with primary angioplasty

This study sought to assess the rate of acute Thrombolysis In Myocardial In farction (TIMI) trial grade 3 patency that can be achieved with the combina tion of prehospital thrombolysis and standby rescue angioplasty in acute my ocardial infarction. No large angiographic study has been performed after p rehospital thrombolysis to determine the 90-minute TIMI 3 potency rate in t he infarct related artery. Hospital outcome and artery patency were compare d to 170 matched patients treated with primary angioplasty. Prehospital thr ombolysis was applied 151 +/- 61 minutes after the onset of pain in 170 pat ients (56 +/- 12 years, 86% men), using recombinant tissue-type plasminogen activator, streptokinase, or eminase. Emergency 90-minute angiography was performed in every case. All patients in whom thrombolysis failed underwent rescue angioplasty. After thrombolysis alone, TIMI grade 3 flow in the inf arct-related artery was observed in 108 patients (64%), TIMI grade 2 in 12 (7%), and TIMI grade 0 or 1 in 50 (29%). Rescue angioplasty was successful in 47 of 50 attempts. Overall, TIMI 3 potency was achieved in 91%, and addi tionally TIMI 2 flow in 7% of patients, an average of 113 +/- 39 minutes af ter thrombolysis and 55 +/- 19 minutes after admission. Therefore, <2 hours after thrombolysis, only 2% of patients had persistent occlusion (TIMI 0 o r 1) of the infarct-related artery. In-hospital mortality was 4% overall (7 of 170), and 3% in the 155 patients in whom TIMI 3 was obtained during the acute phase. Severe hemorrhagic complications occurred in 14 patients (8%) with 2 fatal cerebral hemorrhages (7% of patients required transfusions). The matched comparison with primary PTCA showed no significant difference i n hospital outcome. Combined prehospital thrombolysis, 90-minute angiograph y, and rescue angioplasty yield a high rate of acute TIMI 3 potency rate ea rly after thrombolysis and hospital admission. A randomized, prospective co mparison between these 2 reperfusion strategies may be now warranted. (C)19 99 by Excerpta Medica, Inc.