THURSDAY, July 2 (HealthDay News) -- Rescue percutaneous coronary intervention (R-PCI) is associated with reduced mortality over the long term compared to repeat thrombolysis and conservative therapy, according to research published in the July 7 issue of the Journal of the American College of Cardiology.

Amanda Carver, R.N., of Queensland Health in Brisbane, Australia, and colleagues analyzed follow-up data from 427 patients in the Rescue Angioplasty Versus Conservative Treatment or Repeat Thrombolysis (REACT) trial, who were randomized to repeat lysis, conservative therapy, or R-PCI following failed thrombolysis after acute ST-segment elevation myocardial infarction (STEMI).

The researchers found that, for one-year event-free survival, including death, subsequent acute myocardial infarction and severe heart failure, the adjusted hazard ratio was 0.44 for R-PCI versus repeat thrombolysis and 0.51 for R-PCI versus conservative therapy. Over a median 4.4 years of follow-up, the adjusted hazard ratio for overall mortality was 0.41 for R-PCI compared to repeat thrombolysis and 0.43 for R-PCI versus conservative therapy.

"In patients with STEMI, thrombolysis was proven to be inferior to PCI as stand-alone therapy and even harmful if used in an effort to 'facilitate' subsequent PCI. With this in mind, the only better alternative to rescue PCI is primary PCI. Until this concept is universally accepted and applied, PCI after failed thrombolysis will indeed continue to save patients' lives. However, the survival of thrombolysis as a treatment strategy in STEMI may largely be dependent on the effectiveness of rescue PCI," write the authors of an accompanying editorial.

An editorial author reported financial associations with several pharmaceutical companies. Roche Pharmaceuticals provided repeat thrombolytic for the REACT trial.

Abstract
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