Primary versus rescue percutaneous corollary intervention in patients withacute myocardial infarction

Objective - To compare angiographic and clinical outcomes of patients with acute myocardial infarction (AMI) who underwent primary percutaneous corona ry intervention (PCI) versus rescue PCI following failed thrombolysis. Background - Patients presenting with AMI are treated either with primary P CI or with thrombolysis, When thrombolysis fails, rescue PCI is performed. Methods and Results - We compared the outcome of 105 consecutive patients w ith AMI who underwent either primary PCI (60 patients) or rescue PCI (45 pa tients) between January 1997 and January 1999, The patients were followed f or up to 6 months. Time delay to reperfusion was significantly longer in th e rescue PCI group (354 vs. 189 min; p < 0.001), The majority of patients r eceived a stent (93%). Glycoprotein (GP) IIb/IIIa inhibitors were used in 5 3% of patients in the primary PCI group and in 22% in the rescue group. TIM I grade 3 flow was achieved in 93.3% of patients in the primary PCI group a nd in 88.8% in the rescue group (p = 0.08), Post-procedure ejection fractio n was 53% in the primary PCI group and 47% in the rescue group (p = 0.014), A composite endpoint of death, recurrent MI, repeat PCI, coronary artery b ypass grafting (CABG) and recurrent angina at 6 months occurred in 35% of t he patients in the primary PCI group and 26.7% in the rescue group (p = 0.3 6), Conclusion - Despite a significant delay to reperfusion and a lower immedia te post-procedure ejection fraction, the clinical outcome of patients treat ed with rescue PCI following failed thrombolysis appears to be similar to t hat of patients treated with primary PCI at 6 months.