Rescue Percutaneous Intervention Research Articles

A Randomized Study Comparing Patency of Infarction Related Vessel at Time of Primary PCI in Patients Who Received Streptokinase and Who Did Not

Coronary blood flow in an infarct related artery (IRA) in patients that had streptokinase (SK), as the fibrinolytic of choice before percutaneous intervention (PCI), in comparison to the blood flow in patients that underwent primary percutaneous intervention (PPCI) has not been well understood or considered for studies in recent times. All patients presenting with STEMI diagnosis within less than 12 hours from diagnosis either at the centre or referred to the center after SK were screened. 200 patients were randomized into primary PCI (PPCI) or pharmacoinvasive PCI following SK (PhI-SK) administration 3-24 hours after SK. Failed SK patients underwent rescue PCI immediately. The outcome of IRA patency pre- and post PCI in both groups along with short term outcome of bleeding, re-infarction or cardiovascular death in 30 days were looked at. The end points were reached in 81 of 89 (91.0%) in the SK group and 21 of 98 (21.4%) in the PPCI group (p-value <0.001), while TIMI 3 flow was seen in 87 of 89 (98.7%) patients post PCI in the SK group and 69 of 98 (70.4%) patients of PPCI (p-value <0.001). The outcomes of bleeding, MI and death were not different among the groups. We concluded that Fibrinolysis with SK is a viable and safe reperfusion strategy in STEMI especially in low- and middle-income countries (LMICs), where PPCI is not commonly available within the guideline recommended time. It can reduce stress and risk of complications that can occur during PPCI. There is no any difference in the early outcomes of bleeding, MI and death between the two groups.

Rescue Percutaneous Intervention - Is There a Perfect Time?

Background: Rescue percutaneous coronary intervention (rPCI) for ST elevation myocardial infarction (STEMI) is defined as mechanical reperfusion for failed fibrinolysis. Randomised trials on rPCI are characterised by small study populations and major differences in methodology. In particular, there is no consensus on defining the appropriate timing of rPCI for better outcomes. Aim: To determine an appropriate cut off time period for rPCI in STEMI patients with failed thrombolysis that will predict better outcomes. Methods: We performed a retrospective study on STEMI patients with failed thrombolysis managed by rPCI in the Midland region of New Zealand (NZ) between January 2014 and December 2015. Clinical outcomes assessed were mortality and left ventricular ejection fraction (LVEF) at 12 months follow up. Results: A total of 86 patients underwent rPCI with an average age of 62.87 ± 13.24 SD. There were 71 males (82.56%) and 15 females (17.44%). Average time to rPCI post failed thrombolysis was 511.78 ± 50 SD. Total deaths at 1 year was 18 (20.93%). Mean LVEF on follow up was 46.2% ± 12 SD. Mortality correlated significantly with longer time for rescue (p = 0.0008). There was also a significant negative correlation between LVEF and time to rPCI (p < 0.0001). Cut off point of time to rPCI for predicting abnormal LV function (<50%) is 350 minutes. Conclusion: The benefits of rPCI on mortality and LV function diminish with time. Larger studies are needed to compare outcomes in rPCI vs conservative management to define optimal time windows.

Rescue Percutaneous Intervention in ST Elevation Myocardial Infarction-Impact of Regional Transfer Delays in the Midland Region-Time Does Matter

In New Zealand(NZ)fibrinolysis remains an important treatment for ST elevation myocardial infarction (STEMI). Rescue percutaneous coronary intervention (rPCI), if performed promptly post failed fibrinolytic therapy impacts favourably on clinical outcomes. We report our experience with rPCI over a 2

Bleeding and In-hospital Outcomes in STEMI Patients Treated with Combination of Potent Thienopyridine and Fibrinolytic Therapy, Primary Percutaneous Intervention, Rescue Percutaneous Intervention or Routine Percutaneous Intervention Post Fibrinolytic Therapy in a Regional Setting

Bleeding and In-hospital Outcomes in STEMI Patients Treated with Combination of Potent Thienopyridine and Fibrinolytic Therapy, Primary Percutaneous Intervention, Rescue Percutaneous Intervention or Routine Percutaneous Intervention Post Fibrinolytic Therapy in a Regional Setting

Contribution of guidance by optical coherence tomography (OCT) in rescue management of spontaneous coronary artery dissection

Spontaneous coronary artery dissection (SCAD) is a rare pathology with a poor prognosis, affecting young patients, often peripartum women, without cardiovascular risk factors.1 The SCAD management remains controversial. In the case of haemodynamic instability with coronary occlusion, rescue percutaneous intervention may be required but still challenging.2 A 43-year-old nurse was admitted for acute myocardial infarction complicated by cardiogenic shock. Emergent angiography revealed a total occlusion …

Left main coronary artery transradial rescue percutaneous coronary intervention for acute myocardial infarction complicated by cardiogenic shock with Impella ventricular mechanical support

Mechanical ventricular assist support and especially Impella device that is implanted via femoral access are considered a cornerstone in the therapeutic arsenal of the management of cardiogenic shock. Indeed, the potent antithrombotic agents administered during acute coronary syndromes constitute potential bleeding risk factors. Transradial interventions are nowadays widely used in ST-elevation myocardial infarction patients. However, some operators feel uncomfortable with the transradial approach when facing cardiogenic shock. We report a case of transradial rescue percutaneous intervention for cardiogenic shock in a young man with support of an Impella device via femoral access.

Manual versus nonmanual thrombectomy in primary and rescue percutaneous coronary angioplasty

Although many thrombectomy devices have been tested in ST-segment elevation acute myocardial infarction (STEMI), there are no comparative data on safety or effectiveness in thrombectomy or ST-segment resolution. This study compares manual versus nonmanual thrombectomy devices in patients undergoing primary or rescue percutaneous coronary intervention in a tertiary care center. We identified 232 consecutive patients with STEMI and time from symptom onset to emergency room contact of < or = 12 h undergoing percutaneous coronary intervention with coronary thrombectomy devices. Primary end point was ST-segment resolution of > or = 70%. Several angiographic, procedural and clinical secondary end points were also evaluated. The manual thrombectomy group included 110 patients and the nonmanual group 122 patients. Both groups were similar in their clinical characteristics. The primary end point occurred with similar frequency in patients treated with manual versus nonmanual thrombectomy (67.9% vs 60.0%, P = 0.216). No significant differences were found in the two groups with regard to procedural complications, angiographic reperfusion parameters, in-hospital major adverse cardiac events, or infarct size, whereas manual thrombectomy was associated with a better left ventricle ejection fraction at discharge. Furthermore, treatment with a manual thrombectomy device was associated with significantly shorter procedural times (69 min vs 95 min, P < 0.001) and lower procedural costs (2981 euros vs 7505 euros, P < 0.001). The use of manual thrombus-aspiration catheters appeared equivalent to nonmanual thrombectomy devices in the setting of primary or rescue percutaneous intervention in terms of clinical efficacy, and led to shorter procedures and cost savings.

Arteriotomy closure device application following percutaneous coronary intervention may prevent bleeding complications in patients with acute myocardial infarction

The current study was performed to determine whether application of arteriotomy closure devices (ACDs) affect bleeding complications as compared to manual compression in patients with ST-elevated acute myocardial infarction (STEMI) who undergo primary or rescue percutaneous intervention (PCI). 314 consecutive cases of STEMI treated with PCI were retrospectively evaluated. Overall, 82.8% of patients received ACDs with total bleeding rate of 4.2% vs. 11.1% in patients who had manual compression, p = 0.042. This difference in bleeding rates did not correlate with any clinical characteristic or utilization of GPIIb/IIIa inhibitors. Accordingly, ACDs can improve the acute results of PCI in STEMI patients.

Predictors of Mortality Following Rescue Percutaneous Intervention

Rescue percutaneous transluminal coronary angioplasty (PTCA) is a mechanical reperfusion strategy aimed at achieving patency of the infarct-related artery after failed thrombolysis. However, in randomized studies the indication for rescue PTCA was per protocol rather than based on clinical criteria. The aim of this study was to determine predictors of mortality at 30 days following rescue percutaneous intervention. Seventy-one consecutive patients who underwent rescue PTCA were included. Mean age was 61 (11) years, 80% were men and 9.8% had diabetes. The infarct-related artery was the left anterior descending artery in the 46.5%, and the mean percentage of stenoses was 91.0 (11.6)%. A stent was implanted in 97.2% and TIMI II-III flow was obtained in the 97.2% of the patients. Overall mortality was 9.8% at 30 days follow-up and 11.3% at 1 year follow-up. In the multivariate analysis, the independent predictors of mortality at 30 days were age (OR=1.2, 95% CI: 1.03-1.5, P=.001), Killip class III-IV (OR=20.1; 95% CI: 1.7-500; P=.003), PTCA failure (OR=indeterminate; P=.04) and left anterior descending artery involvement (OR=12.6; 95% CI: 0.7-214.9; P=.04). Rescue PTCA is effective in restoring blood flow in the infarct-related artery in the majority of patients in whom thrombolysis failed. The independent predictors of mortality were similar to those previously reported in acute myocardial infarction.