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A randomized trial of rescue angioplasty versus a conservative approach for failed fibrinolysis in ST-segment elevation myocardial infarction: The Middlesbrough Early Revascularization to Limit INfarction (MERLIN) trial

Lookup NU author(s): Dr Philip Campbell, Dr Janine Gray, Dr James Hall, Dr Alun Harcombe, Amy Wright, Dr Ananthaiah Shyam-Sundar, Dr Adrian Davies, Dr Nicholas Linker, Dr Mark De Belder

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Abstract

Objectives We sought to compare emergency coronary angiography with or without rescue percutaneous coronary intervention (PCI) with conservative treatment in patients with failed fibrinolysis complicating ST-segment elevation myocardial infarction (STEMI). Background Most patients with STEMI receive fibrinolytic therapy and aspirin. The management of failed fibrinolysis is unclear. Methods A total of 307 patients with STEMI and failed fibrinolysis were randomized to emergency coronary angiography with or without rescue PCI or conservative treatment. Results Thirty-day all-cause mortality was similar in the rescue and conservative groups (9.8% vs. 11%, p = 0.7, risk difference [RD] 1.2%, 95% confidence interval [CI] -5.8 to 8.3). The composite secondary end point of death/re-infarction/stroke/subsequent revascularization/heart failure occurred less frequently in the rescue group (37.3% vs. 50%, p = 0.02, RD 12.7%, 95% CI 1.6 to 23.5), driven by less subsequent revascularization (6.5% vs. 20.1%, p < 0.01, RD 13.6%, 95% CI 6.2 to 21.4). Re-infarction and clinical heart failure were less common in the rescue group (7.2% vs. 10.4%, p = 0.3, RD 3.2%, 95% CI -3.3 to 9.9; and 24.2% vs. 29.2%, p = 0.3, RD 5.7%, 95% CI -4.3 to 15.6, respectively). Strokes and transfusions were more common in the rescue group (4.6% vs. 0.6%, p = 0.03, RD 3.9%, 95% CI 0.5 to 8.6; and 11.1% vs. 1.3%, p < 0.001, RD 9.8%, 95% CI 4.9 to 19.9, respectively). Left ventricular function at 30 days was the same in the two groups. Conclusions Rescue angioplasty did not improve survival by 30 days, but improved event-free survival, almost completely due to a reduction in subsequent revascularization. Rescue angioplasty was associated with more strokes and more transfusions and did not result in preservation of left ventricular systolic function at 30 days. © 2004 by the American College of Cardiology Foundation.


Publication metadata

Author(s): Sutton AGC, Campbell PG, Graham R, Price DJA, Gray JC, Grech ED, Hall JA, Harcombe AA, Wright RA, Smith RH, Murphy JJ, Shyam-Sundar A, Stewart MJ, Davies A, Linker NJ, De Belder MA

Publication type: Article

Publication status: Published

Journal: Journal of the American College of Cardiology

Year: 2004

Volume: 44

Issue: 2

Pages: 287-296

ISSN (print): 0735-1097

ISSN (electronic): 1558-3597

Publisher: Elsevier

URL: http://dx.doi.org/10.1016/j.jacc.2003.12.059

DOI: 10.1016/j.jacc.2003.12.059

PubMed id: 15261920


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