Contribution of stenting to the results of rescue PTCA

Abstract

Failed thrombolysis in acute myocardial infarction (AMI) is associated with increased mortality. Controversial benefit of rescue percutaneous transluminal coronary angioplasty (PTCA) in these setting has been published. The feasibility, safety, and contribution of stenting to the outcome of AMI patients treated with this strategy is unknown. We studied the angiographic result and clinical outcome of 33 patients with failed thrombolysis referred for rescue angioplasty. Twenty‐three patients had stenting and 10 patients did not have stenting. Both groups had similar clinical and angiographic characteristics. Stent indications were nonoptimal result, 40%; bailout, 40%; elective, 20%. Angiographic success was 100% with stent vs. 91% with balloon alone (P < 0.8). Postprocedure residual stenosis was 1.5% (0%–10%) with stent vs. 18.05% (0%–30%) with balloon alone (P < 0.01). Thirty‐day outcome with and without stent was mortality, 0% vs. 13% (P < 1.0); reinfarction, 10% vs. 0% (P < 0.30); target vessel revascularization, 0% vs. 21% (P < 0.21). The 6‐month mortality was 0% with stent vs. 14% (P < 0.5). We conclude that stenting during rescue angioplasty is feasible, safe, and is associated with better immediate angiographic results. Although no obvious clinical benefit was found, a potential decrease in the revascularization rate was suggested. Cathet. Cardiovasc. Intervent. 47:411–414, 1999. © 1999 Wiley‐Liss, Inc.

Delayed Post-Myocardial Infarction Invasive Measures, Helpful or Harmful?

“…5,6,10 One of the most important explanations For editorial comment see page 2 may be the relatively low rate of successful reperfusion after performing the rescue procedure, which in turn increases the likelihood of morbidity and mortality. 4,5,7,9,11 Surprisingly, however, there is still no available information focusing on the short-term and long-term outcomes of patients with early or recent myocardial infarction (MI) undergoing routine PCI without preceding thrombolytic therapy.…”

Angiographic and Long-Term Outcomes of “Rescue” Stenting versus PTCA in Failed Thrombolysis in Acute Myocardial Infarction

“…The only disadvantage was a higher incidence of bleeding complications (4/20 patients), which may have been related to the use of the platelet glycoprotein IIb/IIIa inhibitors. In another study, by Cafri et al, 14 patients who had a rescue stent placement had significantly smaller residual stenosis after the procedure when compared with nonstented patients (1.5% versus 18.05% respectively). At 1month follow-up, nonstented patients had higher incidences of death, reischemia, and target vessels revascularization.…”

Rescue Coronary Stenting with Heparin-coated Jostents for Failed Thrombolysis in Acute Myocardial Infarction

“…Recently published reports have suggested that stent implantation during rescue PTCA after failed thrombolysis is feasible and safe and associated with a good clinical outcome. 18,21) Dauerman, et al analyzed the angiographic and clinical outcomes in patients treated with either balloon angioplasty or coronary stenting for thrombolytic failure. 8) Acute stent thrombosis was reported in one of the 45 patients (2.2%), a finding similar to our registry.…”