Elective, early PCI within 24 hours of thrombolysis is safe, effective

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Performing elective, early PCI within 24 hours of administering thrombolytic therapy for acute MI appears safe and effective when compared to delayed PCI, according to a poster presentation at the Cardiovascular Revascularization Therapies (CRT) 2008 held in Washington, D.C., last week.

Thrombolysis is the most common method of reperfusion in the U.S. in acute STEMI, and about two-thirds of these patients have angiography after thrombolytics.

The authors identified early, elective PCI after thrombolysis as controversial, and they said that how early PCI should be performed is currently unknown.

Wissam A. Jaber, MD, of the division of cardiovascular diseases at the Mayo Clinic, and colleagues, examined 757 patients from the Mayo Clinic PCI database, who underwent PCI within one week of receiving thrombolytic therapy for acute MI between 1995 and 2005.

The primary outcomes were: major bleeding (intracranial, fatal or requiring blood transfusion); in-hospital death, MI and CABG; and one-year death or MI.

Of these patients, 353 were performed on a non-emergency basis to be included in the study, according to the researchers. The authors wrote that the thrombolytic agent used was alteplase in 51% of all patients, reteplase in 28%, tenecteplase in 17% and streptokinase in 4%, without difference between groups.

Compared to patients treated in PCI within same day of thrombolysis (Group One), the patients treated more than three days later were more likely to be females with similar characteristics, the authors reported.

The patients were grouped based on the day PCI was performed after lysis: Group One: same day; Group Two: next day; Group Three: day two; and Group Four: day three or later.

Jaber and colleagues found that, in general, females were associated with higher bleeding, risk and worse outcome. After adjusting for gender, Groups One and Two were still associated with a lower risk of in-hospital death or MI than Groups Three and Four, and bleeding risk remained the same across the Groups.

For the one-year outcomes, death or MI for Groups One, Two, Three and Four were respectively 7.6%, 10.9%, 15.4% and 13.5%, the researchers reported.

Adjusting for baseline differences, performing PCI within 24 hours was associated with similar 30 days and one year death and MI rates to PCI performed later, according to the authors.

Jaber and colleagues found that performing elective PCI after successful thrombolysis is safe with an acceptable major bleeding risk (4% to 6%). They also found in-hospital death and MI were seen less often in patients treated earlier; and there was a trend towards a better long-term outcome after connecting for important confounding variables.

Although not conclusive, the study supports performing a large randomized controlled study comparing elective PCI done within 24 hours of successful thrombolysis for acute MI to one performed later, the authors wrote.