Author + information
- Received April 26, 1991
- Revision received August 19, 1991
- Accepted August 28, 1991
- Published online March 1, 1992.
- Stephen G. Ellis, MD, FACC§,1,
- Frans Van de Werf, MD, FACC*,
- Expedito Ribeiro-daSilva, MD† and
- Eric J. Topol, MD, FACC1
- ↵§Address for reprints: Stephen G. Ellis, MD, Cardiac Catheterization Laboratory, The Cleveland Clinic Foundation, F25, One Clinic Center, 9500 Euclid Avenue, Cleveland, Ohio 44195.
Whereas coronary angioplasty has been demonstrated to be unnecessary and perhaps harmful for most patients after successful thrombolytic treatment of acute myocardial infarction, the clinical benefit of rescue angioplasty after failed thrombolysis remains untested in a randomized clinical trial. However, in the clinical judgment of many physicians it is unethical to withhold such treatment, whereas a nearly equal number of physicians believe that such treatment cannot be justified. A review of reported nonrandomized data from a limited number of patients suggests that 1) coronary angioplasty is successful in only 80% of patients after failed thrombolysis, 2) later reocclusion rates may depend on the thrombolytic agent used, 3) left ventricular ejection fraction is seldom improved, and 4) mortality rates after successful angioplasty approximate those after successful thrombolysis alone but mortality rates after failed angioplasty are remarkably high.
The arguments for and against rescue angioplasty are reviewed, and it is concluded that results of randomized trials are needed to replace disparate clinical opinion on whether this potentially costly form of therapy should be widely implemented.
- Received April 26, 1991.
- Revision received August 19, 1991.
- Accepted August 28, 1991.
- American College of Cardiology Foundation