A comparison of rescue and primary percutaneous coronary interventions for acute ST elevation myocardial infarction

Abstract

ObjectiveTo perform a comparative analysis of in-hospital results obtained from patients with acute ST elevation myocardial infarction (STEMI), who underwent rescue or primary percutaneous coronary intervention (PCI). The aim is to determine rescue PCI as a practical option for patients with no immediate access to primary PCI. MethodsFrom the Cardiology PCI Clinic of the National Hospital of Sri Lanka (NHSL), we selected all consecutive patients presenting with acute STEMI </=24h door-to-balloon delay for primary PCI and </=72h door-to-balloon delay, (90min after failed thrombolysis) for rescue PCI, from March 2013 to April 2015 and their in-hospital results were analyzed, comparing rescue and primary PCI patients. ResultsWe evaluated 159 patients; 78 underwent rescue PCI and 81 underwent primary PCI. The culprit left anterior descending (LAD) vessel (76.9% vs. 58.8%; P=0.015) was more prevalent in rescue than in primary patients. Thrombus aspiration was less frequent in rescue group (19.2% vs. 40.7%; p=0.004). The degree of moderate-to-severe left ventricular dysfunction reflected by the ejection fraction <40% (24.3% vs. 23.7%; P=0.927) and prevalence of multivessel disease (41.0% vs. 43.8%; P=0.729) revealed no significant difference. Coronary stents were implanted at similar rates in both strategies (96.2% vs. 92.6%; P=0.331). Procedural success (97.4% vs. 97.5%; P=0.980) and mortality rates (5.1% vs. 3.8%; P=0.674), were similar in the rescue and primary groups. ConclusionIn-hospital major adverse cardiac events (MACE) are similar in both rescue and primary intervention groups, supporting the former as a practical option for patients with no immediate access to PCI facilities.