Document Detail

Rescue angioplasty for failed thrombolysis in older patients: insights from the REACT trial.
MedLine Citation:
PMID:  17482689     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Thrombolysis remains the first-line therapy in a substantial proportion of patients presenting with ST elevation myocardial infarction. The optimal treatment for patients in whom there is failure of reperfusion following thrombolysis is unclear. The Rescue Angioplasty versus Conservative Treatment or Repeat Thrombolysis (REACT) trial demonstrated, in 427 randomly assigned patients with failed reperfusion following thrombolysis, that event-free survival rates were significantly improved with rescue angioplasty compared with either repeat thrombolysis or conservative treatment. However, the safety and efficacy of rescue angioplasty among older patients remains uncertain. METHODS AND RESULTS: We aimed to determine whether rescue angioplasty was safe and effective in an older population, by evaluating the primary and secondary clinical outcomes among the 105 patients >or=70 years of age in the REACT trial. We observed an increased overall 6-month event rate among older patients. The relative benefit of rescue angioplasty versus repeat thrombolysis or conservative treatment was maintained, and the absolute benefit actually increased in this older age group compared with the study population as a whole. There was no adverse impact of advanced age on bleeding complications. Repeat thrombolysis was no more effective than conservative therapy. CONCLUSIONS: Rescue angioplasty is the preferred management strategy for failed thrombolysis, even for patients >or=70 years of age.
Nicholas J Alp; Anthony H Gershlick; Amanda Carver; Suzanne E Stevens; Robert Wilcox
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-05-07
Journal Detail:
Title:  International journal of cardiology     Volume:  125     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-24     Completed Date:  2008-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  254-7     Citation Subset:  IM    
Department of Cardiovascular Medicine, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
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MeSH Terms
Aged, 80 and over
Angioplasty / trends*
Disease Management
Myocardial Infarction / mortality,  physiopathology,  therapy*
Randomized Controlled Trials as Topic / trends*
Retrospective Studies
Thrombolytic Therapy / trends*
Treatment Failure
Grant Support
//British Heart Foundation
Comment In:
Int J Cardiol. 2008 Apr 10;125(2):288-9   [PMID:  18234372 ]

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