BMJ 1998;317:417 ( 8 August )

Letters

Treatment and prognosis after myocardial infarction

    Echocardiography and rescue angioplasty are effective for high risk patients
    Authors' reply

Echocardiography and rescue angioplasty are effective for high risk patients

The first 150 words of the full text of this article appear below.

EDITOR---Lim and Shiels state that pooled data suggest patients do not benefit from rescue angioplasty after failed thrombolysis and that their outcome is adversely affected when interventional techniques fail to open the vessel affected by the infarct.1 They also state that "vigorous clinical assessment" is required before a patient can be classified as high risk after thrombolytic treatment to prevent misinterpretation of signs such as hypotension and sinus tachycardia. Both points should be addressed.

Firstly, the only large scale randomised trial comparing rescue angioplasty with conservative treatment for failed thrombolysis found a significant reduction in the incidence of death or severe heart failure among patients in the rescue angioplasty group (6% v 17%, P=0.05).2 Additionally, the trial was performed without the use of abciximab, a glycoprotein IIb/IIIa inhibitor shown to be beneficial in high risk angioplasty without increasing the risk of haemorrhage.3 The trial also did not incorporate . . . [Full text of this article]
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