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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

View larger version (40K): [in a new window]   Figure 1 Selection of patients from the MITRA and MIR trials.

View larger version (21K): [in a new window]   Figure 2 Multivariate analysis of hospital mortality for primary angioplasty and thrombolysis performed in different subgroups of patients. Adjustment was made for age, gender, location of infarction, cardiogenic shock, previous myocardial infarction (MI), resuscitation, heart failure at hospital admission, pre-hospital delay and type of revascularization, as well as concomitant therapy with beta-blockers and angiotensin-converting enzyme inhibitors. ECG = electrocardiogram.

View larger version (16K): [in a new window]   Figure 3 Relationship between overall mortality and absolute risk reduction of dying by treatment with primary angioplasty compared with thrombolysis in the subgroups analyzed.