Comparison of primary angioplasty with conservative therapy in patients with acute myocardial infarction and contraindications for thrombolytic therapy

The benefit of primary angioplasty in patients with acute myocardial infarc tion (AMI) and contraindications for thrombolysis compared to a conservativ e regimen is still unclear. Out of 5,869 patients with AMI registered by th e MITRA trial, 337 (5.7%) patients had at least one strong contraindication for thrombolytic therapy. Out of these 337 patients 46 (13.6%) were treate d with primary angioplasty and 276 (86.4%) were treated conservatively. Pat ients treated conservatively were older (70 years vs. 60 years; P = 0.001), had a higher rate of a history with chronic heart failure (14.8% vs. 4.4%; P = 0.053), a higher heart rate at admission (86 beats/min vs. 74 beats/mi n; P = 0.001), and a higher prevalence of diabetes mellitus (27.1% vs. 12.8 %; P = 0.056), Patients treated with primary angioplasty received more ofte n aspirin (91.3% vs. 74.6%; P = 0.012), beta-blockers (60.9% vs. 46.1%; P = 0.062), angiotensin converting enzyme (ACE) inhibitors (71.7% vs. 44%; P = 0.001), and the so-called optimal adjunctive medication (54.4% vs. 32.3%; P = 0.004). Hospital mortality was significantly tower in patients who rece ived primary angioplasty (univariate: 2.2% vs. 24.7%; P = 0.001; multivaria te: OR = 0.46; P = 0.0230). In patients with AMI and contraindications for thrombolytic therapy, primary angioplasty was associated with a significant ly lower mortality compared to conservative treatment. Therefore, hospitals without the facilities to perform primary angioplasty should try to refer such patients to centers with the facilities for such a service, if this is possible in an acceptable time. (C) 1994 Wiley-Liss, Inc.