HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

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.

AbstractOBJECTIVES:
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.
AuthorsAndrew G C Sutton, Philip G Campbell, Richard Graham, Dallas J A Price, Janine C Gray, Ever D Grech, James A Hall, Alun A Harcombe, Robert A Wright, Roger H Smith, Jerry J Murphy, Ananthaiah Shyam-Sundar, Michael J Stewart, Adrian Davies, Nicholas J Linker, Mark A de Belder
JournalJournal of the American College of Cardiology (J Am Coll Cardiol) Vol. 44 Issue 2 Pg. 287-96 (Jul 21 2004) ISSN: 0735-1097 [Print] United States
PMID15261920 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
Topics
  • Angioplasty, Balloon, Coronary
  • Coronary Angiography
  • Coronary Circulation
  • Disease-Free Survival
  • Electrocardiography
  • Emergencies
  • Female
  • Heart Failure (etiology)
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction (diagnostic imaging, mortality, physiopathology, therapy)
  • Recurrence
  • Risk Factors
  • Stroke (etiology)
  • Survival Rate
  • Thrombolytic Therapy
  • Treatment Failure

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: