Outcomes of rescue versus primary percutaneous coronary intervention in ST-elevation myocardial infarction.

Abstract

Background: Rescue percutaneous coronary intervention (PCI) is generally thought to have worse outcomes than primary PCI (PPCI). We aimed to determine baseline characteristics, in-hospital and 30-day outcomes of patients with rescue PCI versus PPCI for treatment of ST-elevation myocardial infarction (STEMI). Methods: Patients admitted with STEMI (excluding out-of-hospital cardiac arrest) within the Melbourne Interventional Group registry between 2005-2018 treated with either rescue PCI or PPCI were included. Comparison of 30-day major adverse cardiac events (MACE) and all-cause mortality between the two groups was made. Results: There were 7,271 PPCI patients included and 558 patients with rescue PCI. Patients with rescue PCI were more likely to have presented with cardiogenic shock (12% vs 7%, p<0.001). Rescue PCI patients had greater radial access use (37% vs 27%, p<0.001), higher rates of persistent no reflow (3.7% vs 1.2%, p<0.001), bare-metal stent use (47% vs 41%, p=0.006) and intra-PCI acute closure (2% vs 0.7%, p=0.001). Despite this, 30-day all-cause mortality (5% vs 6%, p=0.47) and MACE (8.9% vs 10.3%, p=0.26) rates were similar. Rates of in-hospital major bleeding (6% vs 3.4%, p=0.002) and 30-day stroke (2.2% vs 0.8%, p<0.001) were higher following rescue PCI, likely due to an excess in haemorrhagic stroke in the rescue patients. Conclusion: With contemporary interventional approaches and medical therapy, there were no significant differences in mortality or MACE at 30 days between rescue and primary PCI in patients with STEMI. Rescue PCI remains a valuable strategy for treating patients with failed thrombolysis.