Rescue Angioplasty versus Conservative Therapy or Repeat Thrombolysis Trial
Presented at
American Heart Association
Scientific Sessions 2004
Presented by Dr. A. H. Gershlick
REACT: 6 month results
Repeat Thrombolysis
Accelerated tPA or reteplase
n=142
Primary Endpoint:
Composite of death, reinfarction, CVA, or severe heart failure at 6 months
REACT: 6 month results
Presented at AHA 2004
427 Acute MI patients with failed thrombolysis
aspirin and thrombolytic therapy (60% received streptokinase) within 6 hours of chest pain onset, <50% resolution of ST changes on ECG at 90 minutes
42% anterior infarctions
Conservative Treatment
IV Unfractionated Heparin
for 24 hours
n=141
Rescue PCI
Angiography with or without
Revascularization
n=144
REACT: 6 month results
Primary Composite Endpoint at 6 Months
(Death, MI, CVA, or severe heart failure)
Presented at AHA 2004
The primary composite endpoint of death, MI, CVA or severe heart failure at 6 months was significantly lower in the rescue PCI group compared with either the repeat thrombolysis group or the conservative management group
Repeat
Thrombolysis
Rescue PCI
Conservative
Management
p<0.001
p=0.002
Presented at AHA 2004
Freedom from revascularization was significantly higher in the rescue PCI group compared with the repeat lysis group or the conservative group. However, major overt bleeding occurred more frequently in the rescue PCI group compared with the other groups (p values unavailable)
Freedom from Revascularization
Major Overt Bleeding
REACT: 6 month results
Repeat
Thrombolysis
Rescue
PCI
Conservative
Management
Repeat
Thrombolysis
Rescue
PCI
Conservative
Management
Among patients with acute MI and failed reperfusion after thrombolytic therapy, treatment with rescue angiography was associated with a reduction in the primary composite endpoint of death, reinfarction, CVA, or severe HF at 6 months compared with both repeat thrombolysis or conservative management.
These six month results reiterate the trial’s preliminary 30-day results presented at the TCT meeting earlier this year.
The secondary positive endpoint of freedom from revascularization was also significantly higher in the rescue angiography group compared with either the thrombolytic or conservative management group
However, bleeding rates were significantly higher in the rescue PCI group
The REACT results support the results of the earlier, smaller RESCUE trial, which showed a trend toward lower death and heart failure with rescue PCI compared with conservative management. On the other hand, these results disagree with those of the recent MERLIN trial, which showed no difference between rescue angiography and conservative treatment strategies at 30 days. Hypotheses offered to explain the opposing outcomes of MERLIN and REACT include differences in initial thrombolysis (↑ streptokinase in MERLIN), concomitant medications (↑ GP IIb/IIIa inhibitors in REACT), and inclusion criteria (↑ time to rescue PCI in MERLIN)
REACT: Summary