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J Am Coll Cardiol, 1998; 32:1687-1694 © 1998 by the American College of Cardiology Foundation |
a Cardiac Catheterization Unit and the Division of Cardiology, Ospedale Santa Croce, Cuneo, Italy
Manuscript received February 18, 1998; revised manuscript received July 1, 1998, accepted July 24, 1998.
Address for correspondence: Dr. Giuseppe Steffenino, Laboratorio di Emodinamica, Ospedale Santa Croce, Via Michele Coppino 26, 12100 Cuneo, Italia
emodinam{at}www.lrcser.it
Objectives. The aim of the study was to compare randomly assigned primary angioplasty and accelerated recombinant tissue plasminogen activator (rt-PA), in patients with "high-risk" inferior acute myocardial infarction (ST-segment elevation in the inferior leads and ST-segment depression in the precordial leads).
Background. The ST-segment depression in the precordial leads is a marker of severe prognosis in patients with inferior myocardial infarction. The comparative outcome of treatment with primary angioplasty or lysis with accelerated rt-PA has not been investigated.
Methods. One hundred and ten patients within 6 h of symptoms were randomized to either treatment. To assess the in-hospital and 1-year outcome of both treatments the following results were compared: death or nonfatal infarction, recurrence of angina, left ventricular ejection fraction (LVEF), and the need for repeat target vessel revascularization (TVR).
Results. In patients treated with angioplasty (55) and rt-PA (55) the rate of in-hospital mortality and reinfarction was 3.6% versus 9.1% (p = 0.4). Recurrence of angina was 1.8% versus 20% (p = 0.002), new TVR was used in 3.6% versus 29.1% (p = 0.0003), and the LVEF (%) at discharge was 55.2 ± 9.5 versus 48.2 ± 9.9 (p = 0.0001). There were no hemorrhagic strokes, no emergency coronary artery bypass graft (CABG) and identical (5.5%) need for blood transfusions. At 1 year, the incidence of death, reinfarction or repeat TVR was 11% in the percutaneous transluminal coronary angioplasty (PTCA) group versus 52.7% in the rt-PA group (log-rank 22.38, p < 0.0001).
Conclusions. Primary angioplasty is superior to accelerated rt-PA in terms of both myocardial preservation and reduction of in-hospital complications in patients with inferior myocardial infarction and precordial ST-segment depression. Primary angioplasty also yields a better long-term event-free survival.
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