Early percutaneous coronary intervention after fibrinolysis for acute ST elevation myocardial infarction: results of two German multi-centre registries (ACOS and GOAL)

Abstract

Objectives: We evaluated the outcome of early percutaneous coronary intervention (PCI) after fibrinolysis in patients presenting with ST elevation myocardial infarction (STEMI) in clinical practice.

Results: 2230 consecutive patients with STEMI treated with fibrinolysis were divided into two groups: patients treated with fibrinolysis only (n = 1540) or with additional PCI (n = 690) within a median of 150 min. In-hospital mortality (9.3% versus 5.9%) and death/myocardial re-infarction (13.9% versus 9.7%) occurred significantly less often in the PCI group. After adjustment for the confounding factors in the propensity score analysis PCI did not significantly affect hospital mortality (OR 0.88, 95% CI 0.57-1.36) and death/myocardial re-infarction (OR 0.86, 95% CI 0.61-1.20) in the overall patients collective. Major bleeding complications were observed more often in the PCI group (7.3% versus 4.2%). In patients with a higher risk profile (TIMI risk score > or = 5) (n = 494) PCI was associated with a significant reduction of hospital mortality (OR 0.40, 95% CI 0.20-0.78) and death/myocardial re-infarction (OR 0.36, 95 % CI 0.19-0.67).

Conclusions: In the overall patients' collective early PCI after fibrinolysis is not associated with an improved clinical outcome. However, in patients with a higher risk profile an early invasive strategy is associated with a risk reduction for mortality and the combined endpoint of death/myocardial re-infarction.