Rescue Angioplasty after Failed Thrombolytic Therapy for Acute Myocardial Infarction

Gershlick, Anthony; Stephens-Lloyd, Amanda; Hughes, Sarah; Abrams, Keith R.; Stevens, Suzanne; Uren, Neal; Belder, Adam de; Davis, John Staige; Pitt, Michael; Banning, Adrian P.; Baumbach, Andreas; Shiu, M F; Schofield, Peter M.; Dawkins, Keith D.; Henderson, Robert A.; Oldroyd, Keith G.; Wilcox, Robert G.

doi:10.1056/nejmoa050849

Cited by 422 publications

(133 citation statements)

References 33 publications

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“…In cases of persistent ST-segment elevation after fibrinolysis, defined as more than half of the maximal initial elevation in the worst ECG lead, and/or persistent ischaemic chest pain, rapid transfer to a PCI centre for rescue angioplasty should be considered [80,87]. Re-administration of a second dose of fibrinolysis was not shown to be beneficial.…”

Section: Delayed Percutaneous Coronary Interventionmentioning

confidence: 99%

Guidelines on myocardial revascularization

Wijns¹,

Kolh²,

Danchin³

et al. 2011

Revista Portuguesa de Cardiologia (English Edition)

238

317

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Section: Delayed Percutaneous Coronary Interventionmentioning

confidence: 99%

Guidelines on myocardial revascularization

Wijns¹,

Kolh²,

Danchin³

et al. 2011

Revista Portuguesa de Cardiologia (English Edition)

238

317

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“…The availability of MCE makes it possible to test reperfusion strategies faster and more directly than was previously possible in clinical trials. Given that a recent study (32) confirmed that rescue PCI was beneficial (in which 90 min ST segment resolution was used to assess reperfusion following thrombolysis), the potential value of a more rapid and accurate technique deserves further study.…”

Section: Discussionmentioning

confidence: 99%

Contrast echocardiography accurately predicts myocardial perfusion before angiography during acute myocardial infarction

Schnell

Kryski

Mann

et al. 2007

Canadian Journal of Cardiology

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O ptimal therapy during acute myocardial infarction (AMI) includes prompt re-establishment of flow in the infarct-related artery (IRA) and effective reperfusion (1-3). Early, spontaneous reperfusion occurs in a small but significant proportion of IRAs (4,5), and the majority are reperfused with thrombolytic therapy. It is difficult to determine whether patency has been achieved at a given time in most patients without cardiac catheterization. The availability of a noninvasive method to rapidly assess myocardial perfusion has important implications in the emergency management of patients presenting with a known or suspected AMI, or after administration of a thrombolytic agent. However, no technique has yet been demonstrated to quickly and reliably predict the effectiveness of reperfusion or status of the IRA.Myocardial contrast echocardiography (MCE) uses an injection of microbubbles to assess myocardial perfusion. MCE can be used to reliably assess myocardial reperfusion following primary percutaneous coronary intervention (PCI) for AMI and to predict improvement in left ventricular (LV) function, as well as to assess the degree of collateral support to the infarcted territory (6-17). However, due to time constraints and the technical demands of OBJECTIVES: To determine whether myocardial contrast echocardiography (MCE) can quickly and accurately assess myocardial perfusion and infarct-related artery (IRA) patency before emergency angiography during acute myocardial infarction (AMI). BACKGROUND: Despite encouraging experimental and clinical studies, the reliability and practicality of MCE in predicting IRA patency during AMI before angiography has not been proven. METHODS: Two-dimensional echocardiography and MCE were performed in 51 patients with AMI just before emergency angiography. With knowledge of the electrocardiogram findings and regional wall motion, myocardial perfusion was assessed to predict IRA patency. RESULTS: Myocardial perfusion studies were adequate for interpretation in 40 patients. An occluded IRA was predicted in 28 patients; the artery was occluded in 22 patients, and six patients had Thrombolysis In Myocardial Infarction (TIMI) grade 2 flow or less. A patent IRA was predicted in 12 patients; eight patients had TIMI grade 3 flow, one patient had TIMI grade 2 flow and the IRA was occluded in three patients. In one of the three patients, the appropriate view was not obtained. In another patient, collateral flow was adequate for nearnormal regional wall motion, and in the last, the findings suggested reperfusion of the proximal artery with distal embolic occlusion. Taken together, MCE accurately predicted either TIMI grade 2 flow or less, or TIMI grade 3 flow in 36 of 40 patients. Sensitivity was 87.5%, specificity and positive predictive value were 100% and negative predictive power was 66.7% (P<0.001). CONCLUSIONS: MCE, together with the electrocardiogram and regional wall motion, can be used to quickly and reliably predict IRA patency early during AMI and may be useful to facilitate a manag...

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“…Es ist sinnvoll, eine Angiographie und PCI bei Patienten mit Fibrinolyse-Versagen durchzuführen, erkennbar an klinischen Zeichen und/oder unzureichender ST-Segment-Resolution [153]. Im Falle einer klinisch erfolgreichen Fibrinolyse (erkennbar am klinischen Bild und einer ST-Segment-Resolution von > 50 %) verbessert eine um einige Stunden nach Fibrinolyse verzögerte Angiographie (der sog.…”

Section: Die Kombination Von Fibrinolyse Und Perkutaner Koronarintervunclassified