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CLINICAL STUDIES

Primary angioplasty versus systemic thrombolysis in anterior myocardial infarction

^a Unit of Interventional Cardiology, Division of Cardiology, "Gregorio Marañón" University General Hospital, Madrid, Spain

Manuscript received March 3, 1998; revised manuscript received September 21, 1998, accepted November 2, 1998.

Reprint requests and correspondence: Dr. Eulogio García, Sección de Hemodinámica, Servicio de Cardiología, Hospital General Universitario "Gregorio Marañón", C/Doctor Esquerdo 46, 28007 Madrid, Spain

OBJECTIVES

This study compares the efficacy of primary angioplasty and systemic thrombolysis with t-PA in reducing the in-hospital mortality of patients with anterior AMI.

BACKGROUND

Controversy still exists about the relative benefit of primary angioplasty over thrombolysis as treatment for AMI.

METHODS

Two-hundred and twenty patients with anterior AMI were randomly assigned in our institution to primary angioplasty (109 patients) or systemic thrombolysis with accelerated t-PA (111 patients) within the first five hours from the onset of symptoms.

RESULTS

Baseline characteristics were similar in both groups. Primary angioplasty was independently associated with a lower in-hospital mortality (2.8% vs. 10.8%, p = 0.02, adjusted odds ratio 0.23, 95% confidence interval 0.06 to 0.85). During hospitalization, patients treated by angioplasty had a lower frequency of postinfarction angina or positive stress test (11.9% vs. 25.2%, p = 0.01) and less frequently underwent percutaneous or surgical revascularization after the initial treatment (22.0% vs. 47.7%, p < 0.001) than did patients treated by t-PA. At six month follow-up, patients treated by angioplasty had a lower cumulative rate of death (4.6% vs. 11.7%, p = 0.05) and revascularization (31.2% vs. 55.9%, p < 0.001) than those treated by t-PA.

CONCLUSIONS

In centers with an experienced and readily available interventional team, primary angioplasty is superior to t-PA for the treatment of anterior AMI.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CABG = coronary artery bypass graft surgery   CK-MB = MB fraction of creatine kinase   LAD = left anterior descending coronary artery   PTCA = percutaneous transluminal coronary angioplasty   t-PA = tissue plasminogen activator

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