RESCUE ANGIOPLASTY IN THE THROMBOLYSIS IN MYOCARDIAL-INFARCTION (TIMI) 4 TRIAL

Rescue percutaneous transluminal coronary angioplasty (PICA) has been used to establish reperfusion after failed thrombolysis, and the goal of this study was to examine the angiographic and clinical outcomes af ter rescue PTCA performed for on occluded artery 90 minutes after thro mbolysis. Four hundred two patients with acute myocardial infarction w ere randomized to receive either anistreplase (APSAC), recombinant tis sue plasminogen activator, or their combination in the Thrombolysis in Myocardial Infarction (TIMI)4 trial. The angiographic and clinical ou tcomes of patients with a potent artery 90 minutes after thrombolysis were compared with those of patients with on occluded artery treated i n a nonrandomized fashion with either rescue or no rescue PICA. At 90 minutes, the number of frames required to opacify standard landmarks ( corrected TIMI frame count) was significantly lower (i.e., flow was fa ster) after successful rescue PTCA (27 +/- 11) than that in patent art eries after successful thrombolysis (39 +/- 20, p <0.001),and the inci dence of TIMI grade 3 flow was correspondingly higher after successful rescue PTCA (87% vs 65%, p = 0.002). In-hospital adverse outcomes (de ath, recurrent acute myocardial infarction, severe congestive heart fa ilure, cardiogenic shock or an ejection fraction <40%) occurred in 29% of successful rescue PTCAs and in 83% of failed rescue PTCAs (p = 0.0 1), Among all patients in whom rescue PTCA was performed (successes an d failures combined), 35% of patients experienced on adverse outcome, which was the same as the 35% incidence observed in patients not under going rescue PTCA (p = NS) and tended to be higher than the 23% incide nce observed in patients with patent arteries (p = 0.07), Although suc cessful rescue PICA for an occluded artery at 90 minutes results in re storation of flow that is superior to that of successful thrombolysis, the incidence of adverse events for the strategy of rescue PICA as a whole was the same as that of undertaking no PICA. (C) 1997 by Excerpt a Medico, Inc.