| Failure of thrombolysis: experience with a policy of early angiography and rescue angioplasty for electrocardiographic evidence of failed thrombolysis. | |
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MedLine Citation:
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PMID: 10908260 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To assess the outcome of a policy of emergency coronary angiography with or without rescue angioplasty in patients with acute myocardial infarction and ECG evidence of failed reperfusion after thrombolysis. DESIGN: A cohort study. SETTING: Regional cardiothoracic unit. PATIENTS: 197 patients with acute myocardial infarction fulfilling a simple ECG criterion of failed reperfusion. INTERVENTIONS: Emergency coronary angiography proceeding to rescue angioplasty for inadequate antegrade flow. MAIN OUTCOME MEASURES: Hospital mortality for all 197 patients; incidence of successful and failed rescue angioplasty; need for additional revascularisation in those receiving rescue angioplasty compared with those not treated in this way. RESULTS: 197 patients had emergency angiography for ECG evidence of failed reperfusion; 156 patients received immediate rescue angioplasty. Overall hospital mortality for those undergoing rescue angioplasty was 11.5%. Rescue angioplasty achieved TIMI 2 (11) or TIMI 3 (124) in 135 patients, who had a hospital mortality of 5.9%. Failure to achieve at least TIMI 2 flow following rescue angioplasty occurred in 21 patients, with a hospital mortality of 48%. In the 41 patients in whom immediate rescue angioplasty was not performed, reinfarction or requirement for revascularisation occurred in 37%. Reinfarction occurred in three patients (1.9%) who had immediate rescue angioplasty. Hospital mortality for the whole cohort was 10.7%. CONCLUSIONS: A policy of emergency coronary angiography proceeding to rescue angioplasty where appropriate reduces mortality in a high risk group to a level less than expected for patients with acute myocardial infarction and ECG evidence of failed reperfusion. Unsuccessful rescue angioplasty is associated with a high mortality. |
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Authors:
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A G Sutton; P G Campbell; E D Grech; D J Price; A Davies; J A Hall; M J Stewart; M A de Belder |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Heart (British Cardiac Society) Volume: 84 ISSN: 1468-201X ISO Abbreviation: Heart Publication Date: 2000 Aug |
Date Detail:
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Created Date: 2000-09-06 Completed Date: 2000-09-06 Revised Date: 2010-09-14 |
Medline Journal Info:
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Nlm Unique ID: 9602087 Medline TA: Heart Country: ENGLAND |
Other Details:
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Languages: eng Pagination: 197-204 Citation Subset: AIM; IM |
Affiliation:
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Cardiothoracic Division, South Cleveland Hospital, Middlesbrough, UK. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Transluminal, Percutaneous Coronary
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methods* Clinical Protocols Cohort Studies Coronary Angiography / methods* Electrocardiography Female Humans Male Middle Aged Myocardial Infarction / therapy* Outcome Assessment (Health Care) Retreatment Salvage Therapy Thrombolytic Therapy / methods* Treatment Failure |
| Comments/Corrections | |
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