Early routine angioplasty versus selective angioplasty after successful thrombolysis in acute ST-segment elevation myocardial infarction.

Objectives: The aim of this study was to evaluate the safety and feasibility of early angioplasty within 12 h and selective angioplasty 1 week later after successful thrombolysis in acute ST-segment elevation myocardial infarction.

Methods: A total of 224 patients with acute ST-segment elevation myocardial infarction who received thrombolysis with reteplase were randomly assigned to an early percutaneous coronary intervention (E-PCI) group or a selective PCI (S-PCI) group. Patients assigned to the E-PCI group received PCI within 12 h after randomization, and patients assigned to the S-PCI group received PCI 1 week later after randomization. The primary end point was a combined end point consisting of death, reinfarction, recurrent ischemia and congestive heart failure during hospitalization. The secondary end points included death, reinfarction, recurrent ischemia, and repeat PCI during 12 months of follow-up.

Results: The baseline clinical characteristics were well balanced between the two groups. The primary end point rate was significantly higher in the S-PCI group compared with the E-PCI group (14.3 vs. 4.5%, P=0.0219). Fewer episodes of recurrent ischemia were observed in the E-PCI group compared with the S-PCI group during hospital stay (0.0 vs. 6.3%, P=0.0212). There were no significant differences in death, reinfarction, recurrent ischemia and repeat PCI between the two groups during 12 months of follow-up.

Conclusion: For patients presenting with an ST-segment elevation myocardial infarction who could not undergo timely primary PCI, thrombolysis followed by PCI within 12 h was a preferred reperfusion strategy and associated with a significant reduction in the recurrent ischemia during hospitalization.