Rescue percutaneous coronary intervention after failed fibrinolytic therapy: Have expectations been met?

Reperfusion therapy for acute myocardial infarction has revolutionized modern cardiovascular care. Two strategies have been tested widely: fibrinolytic therapy and percutaneous coronary intervention (PCI). Fibrinolytic therapy has the advantage that it can be given in many medical care institutions that do not have immediate access to catheterization laboratories. Unfortunately, in a substantial number of patients, fibrinolytic therapy may not achieve optimal results, and a strategy of rescue or salvage PCI may be undertaken. There is a relative paucity of evidence-based outcomes on which to judge the merits of rescue PCI, although the volume is increasing. At present, several recommendations can be offered: (1) implementation of a policy of rescue PCI requires clear guidelines of patient selection, training of personnel, logistics of patient movement, and outcomes assessment; and (2) there needs to be heightened awareness with a high index of suspicion about the potential failure of fibrinolytic therapy.