PTCA following myocardial infarction: Use of bailout fibrinolysis to improve results

The results of percutaneous transluminal coronary angioplasty (PTCA) in 307 lesions in 235 patients within 60 days of myocardial infarction (MI) were compared with the PTCA results in 591 lesions in 489 patients without recent MI, and the effect of fibrinolysis to treat recurring occlusive clot during angioplasty was studied. In 210 lesions in patients with MI who did not receive fibrinolysis during the MI (group A), 58 lesions were categorized as primary failures; bailout fibrinolysis brought the final failure incidence to 42 lesions (20%). In 97 lesions in patients with MI who received fibrinolysis during the acute MI (group B), 22 lesions were categorized as primary failures; bailout fibrinolysis resulted in final failures of 16 lesions (16.5%). In 591 lesions in patients without a recent MI (group C), there were 85 primary failures and 81 final failures after bailout fibrinolysis. Analysis of the PTCA results in each group with respect to whether the lesions were totally or partially occluded showed that more of the lesions attempted in the groups with MI (groups A and B) were totally occluded (TO) and that with use of bailout fibrinolysis the success rate of PTCA in TO lesions was the same in all groups. Similarly, with use of fibinolytic bailout during PTCA the success rate in partially occlusive lesions was not different between the groups. We conclude that bailout thrombolysis during PTCA is usually effective, especially in those who have recently had an MI, and that with availability of bailout fibrinolysis, PTCA in those with recent MI is not any less successful than in those without recent MI. The failure rate seems higher only because more patients with recent MI have total occlusions and totally occluded vessels have a higher incidence of PTCA failure regardless of the presence or absence of a recent MI.