The main limitation of thrombolysis is failure to reperfuse (defined by lack of resolution by >50% of ST segment elevation 90 minutes after thrombolytic administration). This is estimated to occur in up to 30% of patients. These patients should be referred for ‘Rescue PCI’ (PCI performed on a coronary artery that has remained occluded despite thrombolysis) [12].

Thrombolysis, even if successful at achieving early reperfusion, should not be considered the definitive treatment: pre-discharge angiography (within 6-24 hours of thrombolysis) results in improved outcome and is recommended by the European Society of Cardiology: “Lyse now, stent later” [13].

This should not be confused with ‘Facilitated PCI’ which is when PCI is performed immediately after thrombolytic therapy; there is no robust evidence to support this strategy in routine clinical practice [14].

Learning Bite

Up to one third of patients will fail to reperfuse following thrombolysis – Rescue PCI should be performed in these patients.