Improvement in three-month angiographic outcome suggested after primary angioplasty for acute myocardial infarction (Zwolle trial) compared with successful thrombolysis (APRICOT trial)

It has been shown that primary percutaneous transluminal coronary angioplas ty (PTCA) for acute myocardial infarction results in higher potency rates t han thrombolytic therapy. However, no data are available on differences in long-term angiographic outcome after successful primary PTCA compared with successful thrombolysis. Therefore, we compared angiographic data of the An tithrombotics in the Prevention of Reoclusion In:COronary Thrombolysis (APR ICOT) trial and the Zwolle primary PTCA trial. In the APRICOT trial 248 pat ients underwent coronary angiography at a mean of 24 hours after thrombolys is and had a patent infarct-related vessel (Thrombolysis In Myocardial infa rction-3 trial flow)when entering the study. Reocclusion rates were assesse d at a second angiography after 3 months, In the Zwolle trial 136 patients had a successful primary PTCA, At 3 months 131 patients underwent a second angiography; Quantitative coronary angiography showed a significant lower m ean diameter stenosis of the infarct-related vessel after primary PTCA (27 +/- 12% vs 57 +/- 12%; p = 0.00001). At 3 months this difference was sustai ned (35 +/- 22% vs 63 +/- 26%; p = 0.00001). After thrombolysis the reocclu sion rate at 3 months was 29% compared with 5% after primary PTCA (p = 0.00 01), Results show that compared with successful thrombolytic therapy, prima ry PTCA for acute myocordial infarction results in an improved infarct-rela ted vessel status not only short term but also long term, with a low reoccl usion rate. (C) 1999 by Excerpta Medical Inc.