Is rescue reperfusion beneficial after failed thrombolysis in patients with acute myocardial infarction?
Eric Boersma
Correspondence Thoraxcenter, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
Email h.boersma@erasmusmc.nl
This article has no abstract so we have provided the first paragraph of the full text.
A large number of randomized, placebo-controlled trials have demonstrated the effectiveness and safety of fibrinolytic therapy in patients with AMI.1 Fibrinolytic therapy initiated within 3 h of symptom onset results in a 25–30% relative reduction in early mortality when compared with placebo, whereas the proportional mortality reduction is approximately 15% in patients treated later.2 Fibrinolysis, however, fails to restore coronary arterial patency in 20–45% of patients.3 Primary percutaneous coronary intervention (PCI) is associated with a significantly higher success rate. In addition, unlike fibrinolysis, mechanical reperfusion is not associated with an increased risk of intracranial bleeding. In a recently conducted meta-analysis of 23 randomized trials, primary PCI was associated with a 27% relative reduction in early mortality compared with fibrinolysis.4
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