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Published on: November 26, 2013
[A controlled trial with prolonged follow up: percutaneous intervention in acute myocardial infarction is equivalent
P Tornvall1, M Johansson, I Herzfeld
1Kardiologiska kliniken, Karolinska sjukhuset, Stockholm. per.tornvall@ks.se
Insights
Primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction is safe and feasible in Sweden. This study found no significant difference in major adverse events between PCI and thrombolysis after four years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Meta-analyses suggest percutaneous coronary intervention (PCI) is superior to thrombolysis for ST-elevation myocardial infarction (STEMI).
- No randomized controlled trials (RCTs) comparing PCI and thrombolysis have been conducted in Sweden, despite high PCI volumes.
- This study addresses the need for local evidence on primary PCI safety and efficacy in STEMI patients.
Purpose of the Study:
- To evaluate the safety and outcomes of primary PCI in patients with STEMI in Sweden.
- To compare outcomes of primary PCI with those of thrombolysis in a matched cohort.
- To assess the long-term efficacy of primary PCI in a real-world setting.
Main Methods:
- A retrospective analysis of 96 patients with STEMI treated with primary PCI between 1995 and 1998.
- Patients were categorized by indication for PCI: shock, thrombolysis contraindication, or alternative to thrombolysis.
- A matched control group of 55 patients treated with thrombolysis was identified for comparison.
Main Results:
- Mortality rates varied by indication: 67% for shock, 25% for contraindication, and 10% for alternative to thrombolysis.
- After four years, the combined endpoint of death/myocardial infarction/revascularization/angina pectoris occurred in 40% of PCI patients and 52% of thrombolysis patients (not statistically significant).
- Primary PCI was demonstrated to be a safe procedure in the Swedish healthcare system.
Conclusions:
- Primary PCI is a safe and feasible treatment option for ST-elevation myocardial infarction in Sweden.
- While not statistically significant, the trend favored PCI in the long-term combined endpoint analysis.
- The study provides valuable local data supporting the implementation of primary PCI for STEMI.
Abstract:
Previous studies comparing percutaneous coronary intervention (PCI) with thrombolysis for treatment of myocardial infarction with ST-elevation have in meta-analyses but not in randomized trials shown that PCI is more effective. Despite a large volume of primary PCI performed in Sweden no controlled trials have been carried out. The present study included 96 patients with myocardial infarction with ST-segment elevation treated with primary PCI 1995-1998. The main indications were shock (15 cases), contraindication to thrombolysis (24 cases), as an alternative to thrombolysis (57 cases), with a mortality in the respective groups of 67, 25 and 10 percent. Controls matched for age and infarct location and treated with thrombolysis could be identified for 55 of the patients treated with PCI. After four years 40 percent and 52 percent of the patients treated with PCI and thrombolysis respectively reached the combined endpoint of death/myocardial infarction/revascularization/angina pectoris (not significant). In conclusion, the study shows that primary PCI in patients with myocardial infarction with ST-segment elevation can be performed safely also in Sweden.
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