Primary angioplasty versus systemic thrombolysis in anterior myocardial infarction

OBIECTIVES This study compares the efficacy of primary angioplasty and syst emic thrombolysis with t-PA in reducing the in-hospital mortality of patien ts with anterior AMI. BACKGROUND Controversy still exists about the relative benefit of primary a ngioplasty over thrombolysis as treatment for AMI. METHODS Two-hundred and twenty patients with anterior AMI were randomly ass igned in our institution to primary angioplasty (109 patients) or systemic thrombolysis with accelerated t-PA (111 patients) within the first five hou rs from the onset of symptoms. RESULTS Baseline characteristics were similar in both groups. Primary angio plasty 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 re vascularization after the initial. treatment (22.0% vs. 47.7%, p < 0.001) t han 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 b y t-PA. CONCLUSIONS In centers with an experienced and readily available interventi onal team, primary angioplasty is superior to t-PA for the treatment of ant erior AMI. (C) 1999 by the American College of Cardiology.