Angioplastia de resgate no infarto agudo do miocárdio

Abstract

Background: Acute myocardial infarction is a serious and frequent illness, and its treatment with thrombolytic therapy or percutaneous coronary intervention (PCI) is well established. Rescue PCI is an alternative when thrombolysis fails. In the last ten years several clinical studies have tested different features about this procedure. Methods: Eighty four studies about rescue angioplasty published in the major cardiovascular relevance literary sources were analyzed between 1997 to 2007. Results: Rescue PCI was superior to conservative treatment, such as rethrombolysis, when well indicated, and seemed similar to primary PCI, in some features. The concomitant use of GPIIb/IIIa inhibitors seemed to show clinical benefits. The use of drug-eluting stents and the association with mechanic thrombectomy still requires better scientific support. The latest metaanalysis about this topic have shown clear favorable results to rescue angioplasty according to clinical outcomes, heart failure and re-infarction, but not so definite results as to mortality. On the other hand, there was a trend of increased stroke risk, of the same magnitude as benefit. Conclusion: Rescue PCI has better results than conservative treatment or repeat fibrinolysis. However, the indication of the procedure still needs more precise selection criteria as well as better definition of the clinical benefit/safety ratio. These uncertainties persist due to the small number of rescue angioplasty procedures compared to the total number of angioplasties performed. In the CENIC Registry, rescue angioplasty amounts to 4% of all angioplasties performed.

Desfechos hospitalares em pacientes submetidos a intervenção coronária percutânea primária versus de resgate

“…9 Rescue PCI is mandatory for patients who fail post-fibrinolytic reperfusion (segment resolution < 50% in 60 minutes), as it reduces the incidence of MACCE, when compared with re-thrombolysis or with conservative treatment. [10][11][12] There have been few reports in Brazil comparing primary and rescue PCI strategies, including the publication by Mattos et al, 13 using data from CENIC between 1997 and 2000, which showed a higher in-hospital mortality for rescue PCI in a sample in which the use…”

“…Taubaté, SP, Brazil. 12 Trainee cardiologist physician at the Hemodynamics and Interventional Cardiology Services of Hospital Bandeirantes. São Paulo, SP, Brazil.…”