Rescue And Facilitated Angioplasty

Rescue angioplasty typically refers to catheter-based reperfusion following failed therapy with fibrinolysis. Ellis et al. (77) performed a meta-analysis of 11 series of rescue angioplasty, mostly observational, and found that in patients with moderate and large MIs, there was an advantage in survival (92 vs 87%, p = 0.01), reinfarction (3.8 vs 11.7%, p < 0.05), and occurrence of heart failure (4.3 vs 11.3%, p < 0.05), compared with conservative therapy. The largest randomized trial of rescue angioplasty in patients with TIMI 0 to 1 flow after lytic therapy for acute anterior MI also showed a reduction in the 30-d composite of death, reinfarction, or heart failure (16.6 vs 6.4%, p < 0.05)

Fig. 19. Integration of epicardial (TIMI flow grade) (A) and myocardial (TMP grade) (B) perfusion in patients receiving pharmacological reperfusion therapy for acute MI. Adapted from ref. 75.
Fig. 20. Impact of TMP grade in patients with TIMI 3 flow after mechanical reperfusion therapy. Adapted from ref. 76.

Table 5

Trials of Combination Fibrinolysis and GP IIb/IIIa Inhibitors in Acute MI

Table 5

Trials of Combination Fibrinolysis and GP IIb/IIIa Inhibitors in Acute MI

Study (reference)

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