Early coronary intervention following pharmacologic therapy for acute myocardial infarction - (The combined TIMI 10B-TIMI 14 experience)

Earlier studies have suggested that immediate percutaneous coronary interve ntion (PCI) following thrombolytic therapy for acute myocardial infarction (AMI) is associated with an increase in adverse events and that routine PCI in this setting has offered no advantage over a conservative strategy. To reassess this issue in a more recent era, we evaluated 1,938 patients from the Thrombolysis in Myocardial Infarction (TIMI) 10B and 14 trials of AMI. Patients in TIMI 10B were randomized to receive tissue plasminogen activato r or TNK tissue plasminogen activator, whereas patients in TIMI 14B trial w ere randomized to receive thrombolytic therapy with or without abciximab. A ll patients underwent angiography 90 minutes after receiving pharmacologic therapy. Patients who underwent PCI were classified as having undergone a r escue procedure (TIMI 0 or 1 flow at 90 minutes), an adjunctive procedure ( TIMI 2 or 3 flow at 90 minutes), or a delayed procedure (performed > 150 mi nutes after symptom onset, median of 2.75 days). Among patients with TIN 0 or 1 flow, there was a trend for lower 30-day mortality among patients who underwent rescue PCI than among those who did not (6% vs 17%, p = 0.01, adj usted p = 0.28). Patients who underwent adjunctive PCI had similar 30-day m ortality and/or reinfarction as those who underwent delayed PCI. In a multi variate model both had lower 30-day mortality and/or reinfarction than pati ents with "successful thrombolysis" (i.e., TIMI 3 flow at 90 minutes) who d id not undergo revascularization (p = 0.02). Thus, early PCI following AMI is associated with excellent outcomes. Randomized trials of an early invasi ve strategy following thrombolysis are warranted. (C) 2001 by Excerpta Medi ca, Inc.