This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zahn, R. Search for Related Content PubMed PubMed Citation Articles by Zahn, R.

CLINICAL STUDY: MYOCARDIAL INFARCTION

Primary angioplasty versus intravenous thrombolysis in acute myocardial infarction: can we define subgroups of patients benefiting most from primary angioplasty?

Results from the pooled data of the maximal individual therapy in acute myocardial infarction registry and the myocardial infarction registry¹

Ralf Zahn, MD^*, Rudolf Schiele, MD^*, Steffen Schneider, PhD^*, Anselm K. Gitt, MD^*, Harm Wienbergen, MD^*, Karlheinz Seidl, MD^*, Thomas Voigtländer, MD, Martin Gottwik, MD, Gunther Berg, MD, Ernst Altmann, MD^||, Werner Rosahl, MD^¶, Jochen Senges, MD^* for the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) and the Myocardial Infarction Registry (MIR) Study Groups

^* Department of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
Johannes Gutenberg Universität, Mainz, Germany
Klinikum Nürnberg, Nürnberg, Germany
Universitätskliniken Homburg/Saar, Homburg, Germany
^|| Klinikum Friedrichstadt, Dresden, Germany
^¶ Städtisches Klinikum, Dessau, Germany

Manuscript received September 8, 2000; revised manuscript received December 13, 2000, accepted February 13, 2001.

Reprint requests and correspondence: Dr. Ralf Zahn, Department of Cardiology, Herzzentrum Ludwigshafen, Bremserstrasse 79, D-67063 Ludwigshafen, Germany
erzahn{at}aol.com

OBJECTIVES

We sought to determine the effectiveness of primary angioplasty compared with thrombolysis in clinical practice.

BACKGROUND

In clinical practice, primary angioplasty for the treatment of acute myocardial infarction (AMI) has not yet been proven more effective than intravenous thrombolysis, nor have subgroups of patients been identified who would perhaps benefit from primary angioplasty.

METHODS

The pooled data of two AMI registries—the Maximal Individual TheRapy in Acute myocardial infarction (MITRA) study and the Myocardial Infarction Registry (MIR)—were analyzed. A total of 9,906 lytic-eligible patients with AMI, with a pre-hospital delay of 12 h, were treated with either primary angioplasty (n = 1,327) or thrombolysis (n = 8,579).

RESULTS

Despite differences in the patients’ characteristics and concomitant diseases between the two groups, the prevalence of adverse risk factors was balanced. Univariate analysis of hospital mortality showed a more favorable course for patients treated with primary angioplasty: 6.4% versus 11.3% (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.43 to 0.67). This was confirmed by logistic regression analysis (multivariate OR 0.58, 95% CI 0.44 to 0.77). Primary angioplasty was associated with a lower mortality in all subgroups analyzed. We observed a significant correlation between mortality and absolute risk reduction (r = 0.82, p < 0.0001) in the different subgroups: as mortality increased, there was an increase in absolute benefit of primary angioplasty compared with thrombolysis.

CONCLUSIONS

These large registry data showed the effect of primary angioplasty to be more favorable than thrombolysis for the treatment of patients with AMI in clinical practice. This effect was not restricted to special subgroups of patients. As mortality increased, the absolute benefit of primary angioplasty also increased.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   AMI = acute myocardial infarction   ARR = absolute risk reduction   CI = confidence interval   MI = myocardial infarction   MIR = Myocardial Infarction Registry   MITI = Myocardial Infarction Triage Investigators registry   MITRA = Maximal Individual TheRapy in Acute myocardial infarction study   NRMI-2 = National Registry of Myocardial Infarction-2   OR = odds ratio   RR = relative risk   t-PA = tissue plasminogen activator

This article has been cited by other articles:

				T. Huynh, S. Perron, J. O'Loughlin, L. Joseph, M. Labrecque, J. V. Tu, and P. Theroux Comparison of Primary Percutaneous Coronary Intervention and Fibrinolytic Therapy in ST-Segment-Elevation Myocardial Infarction: Bayesian Hierarchical Meta-Analyses of Randomized Controlled Trials and Observational Studies Circulation, June 23, 2009; 119(24): 3101 - 3109. [Abstract] [Full Text] [PDF]

				F. Schiele, N. Meneveau, M. F. Seronde, V. Descotes-Genon, J. Oettinger, F. Ecarnot, J.-P. Bassand, and on behalf of the 'Reseau de Cardiologie de Franche Changes in management of elderly patients with myocardial infarction Eur. Heart J., April 2, 2009; 30(8): 987 - 994. [Abstract] [Full Text] [PDF]

				A. H. Gershlick Managing myocardial infarction in the elderly: time to bury inappropriate concerns instead Eur. Heart J., April 2, 2009; 30(8): 887 - 889. [Full Text] [PDF]

				N. Danchin, E. Durand, and D. Blanchard Pre-hospital thrombolysis in perspective Eur. Heart J., December 1, 2008; 29(23): 2835 - 2842. [Abstract] [Full Text] [PDF]

				G. W. Stone Angioplasty Strategies in ST-Segment-Elevation Myocardial Infarction: Part I: Primary Percutaneous Coronary Intervention Circulation, July 29, 2008; 118(5): 538 - 551. [Full Text] [PDF]

				S. P. Loukogeorgakis, A. T. Panagiotidou, D. M. Yellon, J. E. Deanfield, and R. J. MacAllister Postconditioning Protects Against Endothelial Ischemia-Reperfusion Injury in the Human Forearm Circulation, February 21, 2006; 113(7): 1015 - 1019. [Abstract] [Full Text] [PDF]

				R. H. Mehta, C. B. Granger, K. P. Alexander, E. Bossone, H. D. White, and M. H. Sketch Jr Reperfusion strategies for acute myocardial infarction in the elderly: Benefits and risks J. Am. Coll. Cardiol., February 15, 2005; 45(4): 471 - 478. [Abstract] [Full Text] [PDF]

				T. P. Wharton Jr, L. L. Grines, M. A. Turco, J. D. Johnston, J. Souther, D. C. Lew, A. Z. Shaikh, W. Bilnoski, S. K. Singhi, A. E. Atay, et al. Primary Angioplasty in Acute Myocardial Infarction at Hospitals With No Surgery On-Site (the PAMI-No SOS study) versus transfer to surgical centers for primary angioplasty J. Am. Coll. Cardiol., June 2, 2004; 43(11): 1943 - 1950. [Abstract] [Full Text] [PDF]

				M. Singh, H. H. Ting, B. J. Gersh, P. B. Berger, R. J. Lennon, D. R. Holmes Jr, and K. N. Garratt Percutaneous Coronary Intervention for ST-Segment and Non-ST-Segment Elevation Myocardial Infarction at Hospitals With and Without On-site Cardiac Surgical Capability Mayo Clin. Proc., June 1, 2004; 79(6): 738 - 744. [Abstract] [PDF]

				R. H. Mehta, K. J. Harjai, D. Cox, G. W. Stone, B. Brodie, J. Boura, W. O'Neill, C. L. Grines, and Primary Angioplasty in Myocardial Infarction (PAMI Clinical and angiographic correlates and outcomes of suboptimal coronary flow inpatients with acute myocardial infarction undergoing primary percutaneous coronary intervention J. Am. Coll. Cardiol., November 19, 2003; 42(10): 1739 - 1746. [Abstract] [Full Text] [PDF]

				B. Scheller, B. Hennen, B. Hammer, J. Walle, C. Hofer, V. Hilpert, H. Winter, G. Nickenig, M. Bohm, and SIAM III Study Group Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction J. Am. Coll. Cardiol., August 20, 2003; 42(4): 634 - 641. [Abstract] [Full Text] [PDF]

				F.-J. Neumann and N. Jander How to best counteract the enemies? By ensuring adequate oxygen delivery Eur. Heart J. Suppl., November 1, 2002; 4(suppl_G): G35 - G42. [Abstract] [PDF]

				M. Singh, H. H. Ting, P. B. Berger, K. N. Garratt, D. R. Holmes Jr, and B. J. Gersh Rationale for on-site cardiac surgery for primary angioplasty: a time for reappraisal J. Am. Coll. Cardiol., June 19, 2002; 39(12): 1881 - 1889. [Abstract] [Full Text] [PDF]

				Primary Angioplasty vs. Thrombolysis for Acute MI Journal Watch Cardiology, August 17, 2001; 2001(817): 6 - 6. [Full Text]