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A comparison of rescue and primary percutaneous coronary interventions for acute ST elevation myocardial infarction
11th Annual Cardiology Summit
Faslur Rahuman M B, Jayawardena J B, Francis G R, Niraj M, Wasantha Kumara A H T, Wijesinghe U A D, Haniffa R, Ariyapperuma R, Paramanayakam A,
and De Silva A P.
National Hospital of Sri Lanka, Sri Lanka
National Intensive Care Surveillance
Mahidol Oxford Tropical Medicine Research Unit (MORU)
Faculty of Medicine University of Colombo
Intensive Care National Audit and Research Center
Background: 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 Cardiology PCI Clinic of the National Hospital of Sri Lanka (NHSL), we selected all consecutive patients who
underwent early percutaneous coronary intervention for acute STEMI presenting with ≤ 24 h door-to-balloon delay for primary PCI
and ≤ 72 h door-to-balloon delay, (90 minutes after failed thrombolysis) for rescue PCI from March 2013 to April 2015 and their inhospital
results were analyzed, comparing rescue and primary PCI patients.
Results: We evaluated 159 patients, of which 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=0.003). 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 coronary intervention groups,
supporting the former as a practical option for patients with no immediate access to PCI facilities