Abstract 3802: Frequency, Speed and Efficacy of Guideline Adjudicated Rescue Percutaneous Coronary Intervention Following Contemporary Fibrinolysis
Background: Rescue PCI improves outcomes in pts with early STEMI and ECG defined failed reperfusion following fibrinolysis. Recent rescue trials have enrolled non-consecutive pts mainly treated with streptokinase and drawn from an unknown denominator. Our purpose was to determine the frequency, speed and efficacy of rescue PCI in a consecutive series of contemporary lytic treated patients.
Methods: We adjudicated rescue PCI referral (RR) amongst all 221 pts assigned Tenectaplase/Enoxaparin (TNK) in the WEST study. RR was defined as emergency angiography performed in pts with <50% ST resolution (by core ECG reading) 90 minutes following fibrinolysis. Baseline characteristics, time to treatment, core angiographic findings, NTproBNP at 72 hr and 30 days and markers of infarct size (peak CK, and ECG QRS score at discharge) were examined and compared to other non RR- TNK assigned pts.
Results: Of 221 pts assigned TNK, 53 (24%) had adjudicated RR. Baseline characteristics and interval from symptoms to TNK between RR pts and non-RR pts did not differ. However, RR appeared more likely in pre-hospital enrolled pts (44% vs 22%, p=0.04). Twenty-eight RR pts (53%) required inter-hospital transport for invasive care. Emergent angiography occurred 164 (133–191) min after TNK and 83(42–101) min after the RR triggering ECG. By angiography, 25 RR pts (47%) had TIMI 2 or 3 flow. Rescue PCI was attempted in 50 pts, and was successful in 49 (98%). Final flow was TIMI gd 3 in 39 (78%), gd 2 in 10 (20%). Measures of infarct size and LV dysfunction were higher in RR pts.
Conclusion: One in four patients receiving a contemporary fibrinolytic regimen requires referral for guideline-based rescue PCI yet cannot be readily identified at baseline. Angiographic evidence for reperfusion during the interval between referral and angiography is common, and PCI success rates are high. RR is nevertheless associated with substantially larger infarctions and concomitant neurohumoral evidence of LV dysfunction.