Please use this identifier to cite or link to this item: http://hdl.handle.net/2381/16820
Title: Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction.
Authors: Gershlick, A. H.
Stephens-Lloyd, A.
Hughes, S.
Abrams, K. R.
Stevens, S. E.
Uren, N. G.
de Belder, A.
Davis, J.
Pitt, M.
Banning, A.
Baumbach, A.
Shiu, M. F.
Schofield, P.
Dawkins, K. D.
Henderson, R. A.
Oldroyd, K. G.
Wilcox, R.
REACT Trial Investigators
First Published: 29-Dec-2005
Publisher: Massachusetts Medical Society
Citation: New England Journal of Medicine, 2005, 353 (26), pp. 2758-2768
Abstract: The appropriate treatment for patients in whom reperfusion fails to occur after thrombolytic therapy for acute myocardial infarction remains unclear. There are few data comparing emergency percutaneous coronary intervention (rescue PCI) with conservative care in such patients, and none comparing rescue PCI with repeated thrombolysis.
background The appropriate treatment for patients in whom reperfusion fails to occur after thrombolytic therapy for acute myocardial infarction remains unclear. There are few data comparing emergency percutaneous coronary intervention (rescue PCI) with conservative care in such patients, and none comparing rescue PCI with repeated thrombolysis. methods We conducted a multicenter trial in the United Kingdom involving 427 patients with ST-segment elevation myocardial infarction in whom reperfusion failed to occur (less than 50 percent ST-segment resolution) within 90 minutes after thrombolytic treatment. The patients were randomly assigned to repeated thrombolysis (142 patients), conservative treatment (141 patients), or rescue PCI (144 patients). The primary end point was a composite of death, reinfarction, stroke, or severe heart failure within six months. results The rate of event-free survival among patients treated with rescue PCI was 84.6 percent, as compared with 70.1 percent among those receiving conservative therapy and 68.7 percent among those undergoing repeated thrombolysis (overall P = 0.004). The adjusted hazard ratio for the occurrence of the primary end point for repeated thrombolysis versus conservative therapy was 1.09 (95 percent confidence interval, 0.71 to 1.67; P = 0.69), as compared with adjusted hazard ratios of 0.43 (95 percent confidence interval, 0.26 to 0.72; P = 0.001) for rescue PCI versus repeated thrombolysis and 0.47 (95 percent confidence interval, 0.28 to 0.79; P = 0.004) for rescue PCI versus conservative therapy. There were no significant differences in mortality from all causes. Nonfatal bleeding, mostly at the sheath-insertion site, was more common with rescue PCI. At six months, 86.2 percent of the rescue-PCI group were free from revascularization, as compared with 77.6 percent of the conservative-therapy group and 74.4 percent of the repeated-thrombolysis group (overall P = 0.05). conclusions Event-free survival after failed thrombolytic therapy was significantly higher with rescue PCI than with repeated thrombolysis or conservative treatment. Rescue PCI should be considered for patients in whom reperfusion fails to occur after thrombolytic therapy
DOI Link: 10.1056/NEJMoa050849
eISSN: 1533-4406
Links: http://hdl.handle.net/2381/16820
http://www.nejm.org/doi/full/10.1056/NEJMoa050849
Type: Journal Article
Rights: Archived with reference to SHERPA/RoMEO and publisher website.
Appears in Collections:Published Articles, Dept. of Health Sciences

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