Key result
Rescue PCI yields similar MACE to primary PCI but links to higher bleeding and stroke.
Why the study?
Rescue PCI is generally thought to have worse outcomes than primary PCI in STEMI, motivating an evaluation of short- and long-term outcomes comparing both strategies.
Does rescue PCI compared to primary PCI result in similar short- and long-term outcomes in patients with STEMI?
Cohort (n=7,829)
Yes
Does rescue PCI compared to primary PCI result in similar short- and long-term outcomes in patients with STEMI?
Rescue PCI for STEMI after failed fibrinolysis yields similar 30-day MACE and long-term mortality compared to primary PCI, though it is associated with higher risks of bleeding and stroke.
Answers are grounded in this paper and cite their sources.
Rescue PCI was associated with similar STEMI outcomes to primary PCI; this cohort finding leaves open its role pending randomized safety data.
BACKGROUND: Fibrinolysis is an important reperfusion strategy in the management of ST-elevation myocardial infarction (STEMI) when timely access to primary percutaneous coronary intervention (PPCI) is unavailable. Rescue PCI is generally thought to have worse outcomes than PPCI in STEMI. We aimed to determine short- and long-term outcomes of patients with rescue PCI versus PPCI for treatment of STEMI. METHODS AND RESULTS: Patients admitted with STEMI (excluding out-of-hospital cardiac arrest) within the Melbourne Interventional Group (MIG) registry between 2005 and 2018 treated with either rescue PCI or PPCI were included in this retrospective cohort analysis. Comparison of 30-day major adverse cardiac events (MACE) and long-term mortality between the two groups was performed. There were 558 patients (7.1%) with rescue PCI and 7271 with PPCI. 30-day all-cause mortality (rescue PCI 6% vs. PPCI 5%, p = 0.47) and MACE (rescue PCI 10.3% vs. PPCI 8.9%, p = 0.26) rates were similar between the two groups. Rates of in-hospital major bleeding (rescue PCI 6% vs. PPCI 3.4%, p = 0.002) and 30-day stroke (rescue PCI 2.2% vs. PPCI 0.8%, p < 0.001) were higher following rescue PCI. The odds ratio for haemorrhagic stroke in the rescue PCI group was 10.3. Long-term mortality was not significantly different between the groups (rescue PCI 20% vs. PPCI 19%, p = 0.33). CONCLUSIONS: With contemporary interventional techniques and medical therapy, rescue PCI remains a valuable strategy for treating patients with failed fibrinolysis where PPCI is unavailable and it has been suggested in extenuating circumstances where alternative revascularisation strategies are considered.
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Fernando et al. (2021) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=7,829). Rescue PCI vs. Primary PCI (PPCI) was evaluated on 30-day major adverse cardiac events (MACE) (p=0.26). Rescue PCI for STEMI yielded similar 30-day MACE (10.3% vs 8.9%, p=0.26) and long-term mortality (20% vs 19%, p=0.33) compared to primary PCI, despite higher rates of major bleeding and stroke.
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