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Rescue angiopIlNy for post-MI thrombolysis failure

THERAPY

When thrombolytic agents fail to achieve early patency in acute: anterior myocardial infarction. rescue angioplasty may exert a beneficial effect in some patienlS. according to the results of an international. Otulticentre, randomised study conducted by the RESCUE group.

Death or congestive heart failure at 30 days post­MI were significantly lower in the 78 patients receiving rescue angioplasty than in the 73 patients receiving conventional treatment. The study authors suggest that the observed benefit may be due to improved diastolic andlor systolic function, under stress.

They caution that their results should not be extrapolated to all patients with MI. Their study population was a high-risk group of patients (anterior wall infarcts. low average ejection fraction). and their unusually high angioplasty success rate (92%) may also have produced an ellceptionally high number of favourable outcomes.

The study authors conclude that this study provides suppon for immediate catheterisation and angioplasty of patients with large infarcts who are suspected not to have had early reperfusion within 6-8 hours of symptom onset despite thrombolytic treatment. To identify the patients likeliest to benefit from such treatment, they call for the development of rapid, noninvasive techniques to detect reperfusion.

Ellis SG, Ribeiro da Silva Eo Hcyndricla O. RESCUE InvatiJll<ln. R orybnjut!

I'OIDpIriaorI of rncue ~ wiIh cooservatIve tDIDIflemetll of paDeDlS with early failun: of tbn)mboI)'li$ for II;\I~ aoloCrior myocardial ilUamiocI. Cin:uIatioG 90: 22BO-1214. Nov 1994 ....,.".,