Buller Christopher E, Welsh Robert C, Westerhout Cynthia M, Webb John G, O'Neill Blair, Gallo Richard, Armstrong Paul W
University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada.
Am Heart J. 2008 Jan;155(1):121-7. doi: 10.1016/j.ahj.2007.08.027. Epub 2007 Oct 17.
Rescue percutaneous coronary intervention (PCI) is efficacious after clinical failure of fibrinolytic therapy and is recommended for those with persistent ischemia, hemodynamic, or electrical instability. We sought to describe the frequency of fibrinolytic failure (rescue eligibility) as well as the patient characteristics associated with rescue eligibility, rescue referral, and PCI.
Eligibility, indication, and referral for guideline-based rescue PCI were adjudicated in 221 patients enrolled in the WEST trial. WEST treated patients at earliest medical contact and used a tenectaplase/enoxaparin regimen. Ninety patients (41%) were adjudicated with acute myocardial infarction as rescue eligible of whom 68 were referred for rescue PCI. Baseline characteristics did not predict rescue eligibility or referral. Emergency angiography before PCI performed a median of 82 minutes (interquartile range 50-99) after rescue referral showed TIMI flow grade 2 or 3 in 34 (50%). Percutaneous coronary intervention was adjudicated as successful in 58 of 60 attempts. Procedures began approximately 45 minutes sooner in patients initially admitted to PCI-capable hospitals. Compared to those with clinically successful fibrinolytic therapy, rescue eligible patients demonstrated higher median peak creatine phosphokinase (1889 [1243-3746] vs 999 [440-2048], P < .01) and 30-day median NT-proBNP levels (748 [391-1916] vs 431 [153-1016], P < .01).
Rescue eligibility determined by guideline criteria is common after contemporary fibrinolysis and is not predicted by conventional baseline characteristics. Half of rescue-referred patients are patent at angiography: although contemporary PCI success rates are high, rescue eligibility is associated with larger infarctions.
在纤维蛋白溶解疗法临床失败后，补救性经皮冠状动脉介入治疗（PCI）是有效的，推荐用于有持续性缺血、血流动力学或电不稳定的患者。我们试图描述纤维蛋白溶解失败的频率（补救资格）以及与补救资格、补救转诊和PCI相关的患者特征。
在参加WEST试验的221例患者中，对基于指南的补救性PCI的资格、适应症和转诊进行了判定。WEST在患者最早就诊时进行治疗，并使用替奈普酶/依诺肝素方案。90例患者（41%）被判定为急性心肌梗死有补救资格，其中68例被转诊进行补救性PCI。基线特征不能预测补救资格或转诊。在补救转诊后中位82分钟（四分位间距50 - 99）进行的PCI前急诊血管造影显示，34例（50%）患者的心肌梗死溶栓治疗（TIMI）血流分级为2级或3级。60次尝试中有58次判定PCI成功。最初入住有PCI能力医院的患者手术开始时间约早45分钟。与纤维蛋白溶解疗法临床成功的患者相比，有补救资格的患者肌酸磷酸激酶峰值中位数更高（1889[1243 - 3746]对999[440 - 2048]，P <.01），30天NT - proBNP水平中位数也更高（748[391 - 1916]对431[153 - 1016]，P <.01）。
根据指南标准确定的补救资格在当代纤维蛋白溶解治疗后很常见，且不能由传统基线特征预测。一半的补救转诊患者血管造影显示血管通畅：尽管当代PCI成功率很高，但补救资格与更大面积的梗死相关。
