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Title: Outcomes of rescue versus primary percutaneous coronary intervention in ST-elevation myocardial infarction.
Author: Fernando, H.
Dinh, D.
Brennan, A.
Sharma, A.
Clark, D.
Ajani, A.
Oqueli, Ernesto
Reid, C.
Duffy, S.
Freeman, M.
Stub, D.
Hiew, C.
Issue Date: 2020
Conference Name: 68th Cardiac Society of Australia and New Zealand Annual Scientific Meeting, the International Society for Heart Research Australasian Section Annual Scientific Meeting and the 14th Annual Australia and New Zealand Endovascular Therapies Meeting
Conference Date: December 11-13
Conference Place: Online
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.
Internal ID Number: 01651
Type: Conference
Appears in Collections:Research Output

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