Treatment of acute myocardial infarction by primary coronary angioplasty or intravenous thrombolysis in the "real world" - One-year results from a nationwide French survey
N. Danchin et al., Treatment of acute myocardial infarction by primary coronary angioplasty or intravenous thrombolysis in the "real world" - One-year results from a nationwide French survey, CIRCULATION, 99(20), 1999, pp. 2639-2644
Citations number
24
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-Recent randomized trials comparing primary coronary angioplasty
and intravenous thrombolysis at the acute stage of myocardial infarction ha
ve shown a limited but definite advantage for primary angioplasty. The aim
of this study was to document 1-year outcome in patients receiving either t
hrombolysis or primary angioplasty for acute myocardial infarction in the "
real world."
Methods and Results-We used a nationwide prospective registry of all patien
ts admitted for acute myocardial infarction in French intensive care units
in November 1995. Of the 721 patients who received reperfusion therapy, 152
were treated with primary angioplasty and 569 received intravenous thrombo
lysis. The two groups were remarkably similar with respect to all baseline
descriptors, except that a higher proportion of patients in the angioplasty
group had a history of cerebrovascular accident (10% versus 2%, P<0.01), I
n-hospital outcome was not different in the 2 groups. One-year survival was
85.5% in the angioplasty group and 89.5% in the thrombolysis group (P=0.18
), Multivariate analysis showed that older age, anterior location of infarc
tion, female sex, and history of heart failure were related to 1-year morta
lity. In patients alive on day 5, the use of primary angioplasty and higher
Killip class were additional adverse prognostic indicators.
Conclusions-The results of this large registry of real-world practice indic
ate no survival benefit for patients treated with primary angioplasty compa
red with those who received thrombolytic therapy.