Ten-year experience with early angioplasty in 759 patients with acute myocardial infarction

OBJECTIVE How effective and safe is rescue percutaneous transluminal corona ry angioplasty [PTCA] compared with primary PTCA, and is it cost effective? BACKGROUND In acute myocardial infarction (AMI), primary PTCA has been show n to be beneficial in terms of clinical outcome. In contrast, the value of rescue PTCA has not been established. METHODS In a retrospective analysis, we compared the angiographic and clini cal outcomes of 317 consecutive patients who had rescue PTCA similar to 90 min after failed thrombolysis and 442 patients treated with primary PTCA. A n estimation of interventional costs was compared with tilt: strategies of primary and rescue PTCA or with the strategy of thrombolysis with rescue PC A, when indicated. RESULTS Baseline characteristics between primary and rescue PTCA were compa rable for most variables. Treatment delay was longer for patients who had r escue PTCA: 240 min. versus 195 min. Coronary patency after PTCA was compar able: 90.2% for rescue PTCA and 91.4% for primary PTCA (p = 0.67, power 71. 9%). In-hospital mortality rates were 4.7% and 6.6%, respectively (p = 0.37 ). Also, the other complications were fairly similar during the in-hospital phase and during one-year follow-up. Predictors of death were age, infarct size, localization of AMI, failed PTCA and left main stem occlusion. The e stimated interventional costs during one-year follow-up were $7,377 for pri mary PTCA and $8,246 for rescue PTCA: difference $869 (11.7%). CONCLUSION In this retrospective analysis of 759 patients with AMI, rescue angioplasty early after failed thrombolysis seems to be as effective and sa fe as primary PTCA. In the present evaluation, interventional costs of prim ary PTCA are less than those of rescue PTCA (p = 0.0001). (J Am Coil Cardio l 2000;36:51-8) (C) 2000 by the American College of Cardiology.