A comparison of rescue and primary percutaneous coronary interventions for acute ST elevation myocardial infarction.

OBJECTIVE: To perform a comparative analysis of in-hospital results obtained from patients with acute ST elevation myocardial infarction (STEMI), who underwent rescue or primary percutaneous coronary intervention (PCI). The aim is to determine rescue PCI as a practical option for patients with no immediate access to primary PCI.

METHODS: From the Cardiology PCI Clinic of the National Hospital of Sri Lanka (NHSL), we selected all consecutive patients presenting with acute STEMI </=24h door-to-balloon delay for primary PCI and </=72h door-to-balloon delay, (90min after failed thrombolysis) for rescue PCI, from March 2013 to April 2015 and their in-hospital results were analyzed, comparing rescue and primary PCI patients.

RESULTS: We evaluated 159 patients; 78 underwent rescue PCI and 81 underwent primary PCI. The culprit left anterior descending (LAD) vessel (76.9% vs. 58.8%; P=0.015) was more prevalent in rescue than in primary patients. Thrombus aspiration was less frequent in rescue group (19.2% vs. 40.7%; p=0.004). The degree of moderate-to-severe left ventricular dysfunction reflected by the ejection fraction <40% (24.3% vs. 23.7%; P=0.927) and prevalence of multivessel disease (41.0% vs. 43.8%; P=0.729) revealed no significant difference. Coronary stents were implanted at similar rates in both strategies (96.2% vs. 92.6%; P=0.331). Procedural success (97.4% vs. 97.5%; P=0.980) and mortality rates (5.1% vs. 3.8%; P=0.674), were similar in the rescue and primary groups.

CONCLUSION: In-hospital major adverse cardiac events (MACE) are similar in both rescue and primary intervention groups, supporting the former as a practical option for patients with no immediate access to PCI facilities.