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Angioplasty Best For Thrombolytic Refractory MI

Rescue PCI is better than conservative or continued thrombolytic therapy

THURSDAY, Dec. 29 (HealthDay News) -- Emergency percutaneous coronary intervention (rescue PCI) improves event-free survival in patients with acute myocardial infarction (MI) who are refractory to thrombolytic therapy, according to a study in the Dec. 29 issue of the New England Journal of Medicine.

Anthony H. Gershlick, M.B., B.S., of the University Hospitals of Leicester, U.K., and colleagues randomly assigned 427 patients with failed reperfusion after thrombolytic therapy for an acute ST-segment elevation MI to either rescue PCI, conservative treatment, or continued thrombolytic therapy. The study was conducted at 35 different centers between December 1999 and March 2004.

Six-month event-free survival was higher in the rescue PCI group than those receiving conservative therapy or repeated thrombolysis (84.6%, 70.1% and 68.7%, respectively). No differences in all-cause mortality were observed, but nonfatal bleeding was more common in the rescue PCI group, perhaps due to the use of GPIIb/IIIa receptor inhibitors.

"These results indicate that rescue PCI, with transfer to a tertiary site if required, should be considered for patients in whom thrombolysis for myocardial infarction with ST-segment elevation fails to achieve reperfusion," the authors conclude.

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