Abstract 3800: Rescue Angioplasty Versus Conservative Management After Failed Thrombolysis in ST-Segment Elevation Acute Myocardial Infarction: Meta-Analysis of Randomized Controlled Trials
Background: Intravenous thrombolysis is the appropriate reperfusion therapy for ST-segment elevation acute myocardial infarction (STEMI) in hospitals where primary percutaneous intervention is not readily available. However, pharmacological reperfusion is successful in restoring infarct-related artery patency in only 50 – 60 % of patients. It is unclear whether conservative management or rescue angioplasty should be employed to treat patients in whom thombolysis has failed to restore patency of the infarct-related artery. We conducted a systematic review and meta-analysis to determine the benefits and risks of rescue angioplasty compared to conservative management in the treatment of patients with STEMI who have failed intravenous thrombolysis.
Methods: Four clinical trials randomizing patients to rescue angioplasty or conservative management were identified by electronic searches of MEDLINE (1966–2006), PUBMED and Cochrane Central Registry. A random effects model was used to combine results from individual trials and calculate summary odds ratios for the end points of interest.
Results: The 4 trials randomized 771 patients of whom 391 had received rescue angioplasty. Failure of thrombolysis was based upon clinical criteria in 2 studies and angiographic (TIMI 0–1 flow) criteria in 2 studies. Follow-up ranged from hospital discharge to 180 days. The trials randomized predominantly males with a mean age of 58 – 63 years of age. Rescue angioplasty was associated with a significant 41% reduction in risk of mortality (Odds Ratio [OR], 0.588; 95% CI, 0.354 – 0.975; P=.039) and a significant 59% reduction in risk of subsequent revascularization (OR, .412; 95% CI, 0.176 – 0.965; P=.041). However, there was a significant 4.8-fold increased risk of stroke (OR, 4.85; 95% CI, 1.03–22.7; P=0.045).
Conclusions: In patients who have failed intravenous thrombolytic therapy, rescue angioplasty reduced the risk of mortality and the need for revascularization as compared with conservative therapy. However, rescue angioplasty was associated with a significant increase in the risk of stroke.