Percutaneous transluminal coronary angioplasty versus thrombolysis in acute myocardial infarction - A prospective, matched, controlled study

The aim of this study was to evaluate the outcome of primary percutaneous t ransluminal coronary angiography (PTCA) in the treatment of acute myocardia l infarction (AMI) The study included patients with electrocardiographic si gns of transmural AMI, symptom duration of less than 12 h, and with no cont raindications to thrombolytic therapy. Patients who had undergone primary P TCA were matched consecutively, for age, gender, infarct localization and d uration of symptoms, to patients who had received thrombolytic therapy (82 patients to each group). Patients who were admitted to hospital during dayt ime had a primary PTCA, whereas those admitted outside daytime were given t hrombolytic therapy. In the primary PTCA group, 9 patients had a combined e ndpoint compared with 22 patients in the thrombolysis group (p < 0.02). In- hospital mortality was 3.7% in the PTCA group and 4.9% in the thrombolysis group (ns). At six months, a combined endpoint occurred in 23 patients in t he primary PTCA group and in 50 patients in the thrombolysis group (p < 0.0 0005). Six months' mortality was 4.9% in the PTCA group and 7.3% in the thr ombolysis group (ns). Among patients in the PTCA group, left ventricular ej ection fraction was significantly higher, stay in hospital was shorter and there were significantly fewer incidences of heart failure and severe arrhy thmias than among patients in the thrombolysis group. The results of primar y PTCA implemented in our departments are comparable with those reported in randomized trials from experienced centres. Our study indicates that patie nts treated with primary PTCA have fewer complications, a better left ventr icular systolic function and a shorter hospital stay compared with patients treated with thrombolysis.