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Angioplasty vs. Thrombolysis in Acute MI: Long-Term Outcomes
In a recent analysis of studies comparing immediate angioplasty or thrombolytic therapy for patients with myocardial infarction, 1-month outcomes appeared more favorable with angioplasty (see JW Jan 15 1998, p. 16, accession number 971226001, and JAMA 1997; 278:2093). Because the longer-term outcomes were still in question, these Dutch researchers updated the results of a previously published trial in which 395 patients with acute MI were randomized to primary angioplasty or thrombolytic therapy with streptokinase.
During an average follow-up of 5 years, all-cause mortality was significantly lower in the angioplasty group than in the streptokinase group (13 percent vs. 24 percent), with the difference entirely explained by reduced cardiac mortality. The angioplasty group also experienced significantly lower rates of nonfatal reinfarction (6 percent vs. 22 percent), additional angioplasty procedures (26 percent vs. 52 percent), and hospital readmissions for ischemia or heart failure.
Comment: In the debate about the relative merits of primary angioplasty and thrombolysis, these results come down on the side of angioplasty. However, many hospitals currently are unable to provide primary angioplasty by an experienced team during the few hours after the onset of MI. Finally, an editorial notes that ongoing studies will provide additional information on the roles of stenting, new platelet-inhibiting drugs, and combination therapy with both thrombolysis and primary angioplasty.
— AS Brett
Published in Journal Watch General Medicine November 12, 1999
Citation(s):
Zijlstra F. Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1999 Nov 4 341 1413-1419.
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Faxon DP and Heger JW. Primary angioplasty -- enduring the test of time. N Engl J Med 1999 Nov 4 341 1464-1465.
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- Medline abstract (Free)