Kunadian Babu, Vijayalakshmi Kunadian, Dunning Joel, Sutton Andrew G C, Muir Douglas F, Wright Robert A, Hall James A, de Belder Mark A
The James Cook University Hospital, Marton Road, Middlesbrough, Cleveland TS4 3BW, United Kingdom.
Catheter Cardiovasc Interv. 2008 Feb 1;71(2):138-45. doi: 10.1002/ccd.21273.
Rescue angioplasty (rPCI) for failed fibrinolysis is associated with a low mortality if successful, but a high mortality if it fails. The latter may reflect a high-risk group or harm in some patients. Predictors of success or failure of rPCI may aid selection of patients to be treated.
Unselected patients referred for rPCI from March 1994 to March 2005 were studied to determine the predictors of a failed procedure and 1-year mortality.
Of 440 patients undergoing emergency coronary angiography for failed fibrinolysis (1-year mortality 18%), 101 had thrombolysis in myocardial infarction flow grade (TFG) 3 in the infarct-related vessel. rPCI was attempted in 318 of 339 patients with <TFG 3 flow, but not in 21 patients (angiography-produced TFG 3 [n = 7] or unsuitable anatomy [n = 14]). Of the rPCI cohort, 77% had a successful procedure (no in-lab death or emergency coronary artery bypass grafting and TFG 3 in the infarct-related vessel); rPCI failed in 23%. One-year mortality rates for successful and failed rPCI were 14 and 43%, respectively. Patients with failed rPCI were older and more likely to be diabetic, have anterior MI, be interhospital transfers, be in cardiogenic shock, and less likely to be a current smoker. Shock was the only independent predictor of failed rPCI. Age group >75 years, shock, and final TFG < 3 were independent predictors of 1-year mortality.
Cardiogenic shock is an independent predictor of a failed rPCI. Age group >75 years and shock were the only independent clinical predictors of 1-year mortality. These clinical variables may help in selecting patients for either a strategy of rescue angioplasty after failed fibrinolysis, or in selecting specific patients who might do better with a policy of primary angioplasty.
溶栓失败后行补救性血管成形术（rPCI）若成功则死亡率较低，但若失败则死亡率较高。后者可能反映了一部分高危患者群体或某些患者受到的损害。rPCI成功或失败的预测因素可能有助于选择合适的治疗患者。
对1994年3月至2005年3月因rPCI而转诊的未经过筛选的患者进行研究，以确定手术失败和1年死亡率的预测因素。
440例因溶栓失败接受急诊冠状动脉造影的患者（1年死亡率18%）中，101例梗死相关血管的心肌梗死溶栓血流分级（TFG）为3级。339例TFG<3级血流的患者中有318例尝试了rPCI，但21例未尝试（血管造影产生的TFG 3级[7例]或解剖结构不适合[14例]）。在rPCI队列中，77%的手术成功（无术中死亡或急诊冠状动脉旁路移植术，且梗死相关血管的TFG为3级）；23%的rPCI失败。rPCI成功和失败患者的1年死亡率分别为14%和43%。rPCI失败的患者年龄较大，更可能患有糖尿病、前壁心肌梗死、为院间转诊患者、处于心源性休克状态，且当前吸烟者较少。休克是rPCI失败的唯一独立预测因素。年龄>75岁、休克和最终TFG<3是1年死亡率的独立预测因素。
心源性休克是rPCI失败的独立预测因素。年龄>75岁和休克是1年死亡率仅有的独立临床预测因素。这些临床变量可能有助于选择在溶栓失败后行补救性血管成形术策略的患者，或选择采用直接血管成形术策略可能效果更好的特定患者。
