What is the benefit of transferring a patient for PCI of a persistently occluded infarct artery?
Several trials in the stent era and several meta-analyses have examined the role of PCI for fibrinolytic failure and report a trend toward a lower mortality rate and significantly lower rates of recurrent MI and HF among patients treated with rescue PCI for failed fibrinolysis. The primary endpoint, a composite of death, reinfarction, stroke, or severe HF at 6 months, was significantly lower among patients randomized to rescue PCI than among those randomized to conservative care or repeat fibrinolysis. Minor bleeding was significantly higher among patients randomized to rescue PCI; however, the benefit likely justifies these risks, especially if cardiogenic shock, significant hypotension, severe HF, or ECG evidence of an extensive area of myocardial jeopardy is present. In these circumstances, the benefits are greatest if PCI is initiated early after fibrinolytic failure.