Routine PCI after thrombolytic therapy?
Routine PCI after thrombolytic therapy? With delay from onset of symptoms, mortality increases with both thrombolysis and percutaneous coronary intervention (PCI), more with the former. PCI after thrombolysis is considered under three headings: facilitated, rescue and systematic. Mortality and major bleeding are higher in facilitated PCI, compared to primary PCI. Rescue PCI is for unsuccessful thrombolysis based on poor resolution of ST elevation and poor relief of pain. Rescue PCI patients benefit in terms of lower mortality than conservative management.
In systematic PCI, transportation for PCI is done for all patients after thrombolysis. This pharmacoinvasive therapy showed good results in all. Recurrent events are much lesser. TRANSFER-AMI by Warren J Cantor, David Fitchett, Bjug Borgundvaag, John Ducas, Michael Heffernan, Eric A Cohen, Laurie J Morrison, Anatoly Langer, Vladimir Dzavik, Shamir R Mehta, Charles Lazzam, Brian Schwartz, Amparo Casanova and Shaun G Goodman, the TRANSFER-AMI Trial Investigators was one of the trials documenting this. This was in spite of a high cross over from standard treatment group to pharmacoinvasive therapy group. Systematic PCI is done after about three hours, but within 24 hours of thrombolysis.
- Warren J Cantor, David Fitchett, Bjug Borgundvaag, John Ducas, Michael Heffernan, Eric A Cohen, Laurie J Morrison, Anatoly Langer, Vladimir Dzavik, Shamir R Mehta, Charles Lazzam, Brian Schwartz, Amparo Casanova, Shaun G Goodman, TRANSFER-AMI Trial Investigators. Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Engl J Med. 2009 Jun 25;360(26):2705-18.