Sunday October 5, 2008
Early percutaneous coronary intervention after fibrinolysis for acute ST elevation MI: Is there any role?

Bauer and his colleague evaluated the outcome of early percutaneous coronary intervention (PCI) after fibrinolysis in patients presenting with ST elevation MI. 2230 consecutive patients with STEMI treated with fibrinolysis were divided into two groups:

• patients treated with fibrinolysis only (n = 1540) or
• with additional PCI (n = 690) within a median of 150 min

Results:

• In-hospital mortality (9.3% versus 5.9%) and death/myocardial re-infarction (13.9% versus 9.7%) occurred significantly less often in the PCI group but after adjustment for the confounding factors in the propensity score analysis PCI did not significantly affect hospital mortality and death/myocardial re-infarction in the overall patient collective.
• Major bleeding complications were observed more often in the PCI group (7.3% versus 4.2%).
• In patients with a higher risk profile (TIMI risk score more than/=5) (n = 494) PCI was associated with a significant reduction of hospital mortality and death/myocardial re-infarction
  

Conclusions: In the overall patients' collective early PCI after fibrinolysis is not associated with an improved clinical outcome. However, in patients with a higher risk profile an early invasive strategy is associated with a risk reduction for mortality and the combined endpoint of death/myocardial re-infarction.

Reference: click to get abstract

Brauer T, Koeth O et al. Early percutaneous coronary intervention after fibrinolysis for acute ST elevation myocardial infarction: results of two German multi-center registries (ACOS and GOAL). Acute cardiac Care 2007; 9 (2): 97-103