| Rescue angioplasty after failed fibrinolysis for acute myocardial infarction: predictors of a failed procedure and 1-year mortality. | |
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MedLine Citation:
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PMID: 18231990 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Rescue angioplasty (rPCI) for failed fibrinolysis is associated with a low mortality if successful, but a high mortality if it fails. The latter may reflect a high-risk group or harm in some patients. Predictors of success or failure of rPCI may aid selection of patients to be treated. METHODS: Unselected patients referred for rPCI from March 1994 to March 2005 were studied to determine the predictors of a failed procedure and 1-year mortality. RESULTS: Of 440 patients undergoing emergency coronary angiography for failed fibrinolysis (1-year mortality 18%), 101 had thrombolysis in myocardial infarction flow grade (TFG) 3 in the infarct-related vessel. rPCI was attempted in 318 of 339 patients with <TFG 3 flow, but not in 21 patients (angiography-produced TFG 3 [n = 7] or unsuitable anatomy [n = 14]). Of the rPCI cohort, 77% had a successful procedure (no in-lab death or emergency coronary artery bypass grafting and TFG 3 in the infarct-related vessel); rPCI failed in 23%. One-year mortality rates for successful and failed rPCI were 14 and 43%, respectively. Patients with failed rPCI were older and more likely to be diabetic, have anterior MI, be interhospital transfers, be in cardiogenic shock, and less likely to be a current smoker. Shock was the only independent predictor of failed rPCI. Age group >75 years, shock, and final TFG < 3 were independent predictors of 1-year mortality. CONCLUSIONS: Cardiogenic shock is an independent predictor of a failed rPCI. Age group >75 years and shock were the only independent clinical predictors of 1-year mortality. These clinical variables may help in selecting patients for either a strategy of rescue angioplasty after failed fibrinolysis, or in selecting specific patients who might do better with a policy of primary angioplasty. |
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Authors:
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Babu Kunadian; Kunadian Vijayalakshmi; Joel Dunning; Andrew G C Sutton; Douglas F Muir; Robert A Wright; James A Hall; Mark A de Belder |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions Volume: 71 ISSN: 1522-726X ISO Abbreviation: Catheter Cardiovasc Interv Publication Date: 2008 Feb |
Date Detail:
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Created Date: 2008-03-10 Completed Date: 2008-04-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100884139 Medline TA: Catheter Cardiovasc Interv Country: United States |
Other Details:
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Languages: eng Pagination: 138-45 Citation Subset: IM |
Copyright Information:
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Copyright 2008 Wiley-Liss, Inc. |
Affiliation:
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The James Cook University Hospital, Marton Road, Middlesbrough, Cleveland TS4 3BW, United Kingdom. babukunadian@aol.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary* Comorbidity Coronary Angiography Female Humans Intra-Aortic Balloon Pumping Male Middle Aged Myocardial Infarction / drug therapy, epidemiology, mortality*, therapy* Patient Selection Radiography, Interventional Retreatment Shock, Cardiogenic / mortality Survival Analysis Thrombolytic Therapy* Time Factors Treatment Failure |
| Comments/Corrections | |
Comment In:
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Catheter Cardiovasc Interv. 2008 Feb 1;71(2):146
[PMID:
18231991
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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