Long-term outcome after primary angioplasty: Report from the Primary Angioplasty in Myocardial Infarction (PAMI-I) Trial

OBJECTIVES This study sought to compare the two-year outcome after primary percutaneous coronary angioplasty or thrombolytic therapy for acute myocard ial infarction. BACKGROUND Primary angioplasty, that is, angioplasty without antecedent thr ombolytic therapy, has been shown to be an effective reperfusion modality f or patients suffering an acute myocardial infarction. This report reviews t he two-year clinical outcome of patients randomized in the Primary Angiopla sty in Myocardial Infarction trial. METHODS At 12 clinical centers, 395 patients who presented within 12 h of t he onset of myocardial infarction were randomized to undergo primary angiop lasty (195 patients) or to receive tissue-type plasminogen activator (t-PA) (200 patients) followed by conservative care. Patients were followed by ph ysician visits, phone call, letter and review of hospital records for any h ospital admission at one month, six months, one year and two years. RESULTS At two years, patients undergoing primary angioplasty had less recu rrent ischemia (36.4% vs. 48% for t-PA, p = 0.026), lower reintervention ra tes (27.2% vs. 46.5% for t-PA, p < 0.0001) and reduced hospital readmission rates (58.5% vs. 69.0% for t-PA, p = 0.035). The combined end point of dea th or reinfarction was 14.9% for angioplasty versus 23% for t-PA, p = 0.034 . Multivariate analysis found angioplasty to be independently predictive of a reduction in death, reinfarction or target vessel revascularization (p = 0.0001). CONCLUSIONS The initial benefit of primary angioplasty performed by experie nced operators is maintained over a two-year follow-up period with improved infarct-free survival and reduced rate of reintervention. (C) 1999 by the American College of Cardiology.