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Published on: November 26, 2013
Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction
F Zijlstra1, J C Hoorntje, M J de Boer
1Department of Cardiology, Hospital De Weezenlanden, Zwolle, The Netherlands. v.derks@diagram-zwolle.nl
Insights
Primary angioplasty for acute myocardial infarction significantly reduces long-term death and reinfarction compared to streptokinase. This approach also lowers hospital readmissions and total medical costs over five years.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Primary percutaneous coronary intervention (PCI) demonstrates superior infarct-related artery patency, reduced stroke and reinfarction rates, and improved short-term survival over thrombolytic therapy.
- However, comparative long-term efficacy data between primary PCI and thrombolysis for acute myocardial infarction (AMI) remain limited.
Purpose of the Study:
- To compare the long-term clinical efficacy and economic impact of primary angioplasty versus intravenous streptokinase in patients with acute myocardial infarction.
Main Methods:
- A randomized trial involving 395 patients with AMI, assigned to either primary angioplasty or intravenous streptokinase.
- Clinical outcomes and medical charges were tracked for an average of 5 years post-intervention.
Main Results:
- Primary angioplasty (194 patients) showed significantly lower mortality (13% vs. 24%) and nonfatal reinfarction (6% vs. 22%) compared to streptokinase (201 patients).
- Early (30-day) and late (after 30 days) composite endpoints of death and reinfarction were substantially reduced with angioplasty.
- Angioplasty patients experienced fewer readmissions for heart failure and ischemia, with lower overall medical charges ($16,090 vs. $16,813).
Conclusions:
- Over a five-year follow-up, primary angioplasty for AMI offers superior long-term outcomes, including reduced early and late mortality and reinfarction, compared to streptokinase.
- Primary angioplasty also leads to fewer hospital readmissions for cardiac events and is more cost-effective than thrombolytic therapy in the long term.
Background:
As compared with thrombolytic therapy, primary coronary angioplasty results in a higher rate of patency of the infarct-related coronary artery, lower rates of stroke and reinfarction, and higher in-hospital or 30-day survival rates. However, the comparative long-term efficacy of these two approaches has not been carefully studied.
Methods:
We randomly assigned a total of 395 patients with acute myocardial infarction to treatment with angioplasty or intravenous streptokinase. Clinical information was collected for a mean (+/-SD) of 5+/-2 years, and medical charges associated with the two treatments were compared.
Results:
A total of 194 patients were assigned to undergo primary angioplasty, and 201 to receive streptokinase. Mortality was 13 percent in the angioplasty group, as compared with 24 percent in the streptokinase group (relative risk, 0.54; 95 percent confidence interval, 0.36 to 0.87). Nonfatal reinfarction occurred in 6 percent and 22 percent of the two groups, respectively (relative risk, 0.27; 95 percent confidence interval, 0.15 to 0.52). The combined incidence of death and nonfatal reinfarction was also lower among patients assigned to angioplasty than among those assigned to streptokinase, with a relative risk of 0.13 (95 percent confidence interval, 0.05 to 0.37) for early events (within the first 30 days) and a relative risk of 0.62 (95 percent confidence interval, 0.43 to 0.91) for late events (after 30 days). The rates of readmission for heart failure and ischemia were also lower among patients in the angioplasty group than among patients in the streptokinase group. Total medical charges per patient were lower in the angioplasty group (16,090 dollars) than in the streptokinase group (16,813 dollars, P=0.05).
Conclusions:
During five years of follow-up, primary coronary angioplasty for acute myocardial infarction was associated with lower rates of early and late death and nonfatal reinfarction, fewer hospital readmissions for ischemia or heart failure, and lower total medical charges than treatment with intravenous streptokinase.
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