[Thrombolysis or percutaneous coronary intervention in acute myocardial infarct]

Reperfusion therapy in acute ST-elevation myocardial infarction includes thrombolytic therapy and primary percutaneous transluminal coronary angioplasty (pPTCA) or primary coronary intervention (pPCI). Many clinical trials have been done to compare the efficacy of treatment of patients with acute myocardial infarction with thrombolytic therapy vs. primary coronary angioplasty. A meta-analysis of 23 randomized trials including 7739 patients with acute myocardial infarction (AMI) showed better results with pPCI in reducing overall short-term death (7% vs. 9%, p = 0.0002), non-fatal reinfarction (2.5% vs. 6.8%, p < 0.0001), death excluding cardiogenic shock (5% vs. 7, p = 0.0003) and combined endpoint of death, non-fatal reinfarction and stroke (8% vs. 14%, p < 0.0001). Primary PCI was better than thrombolytic therapy irrespective of the type of thrombolytic agent used even then when reperfusion was delayed because of patient transfer to a corresponding teriary center for primary PCI. Primary PCI is more effective than thrombolytic therapy for the treatment of ST-segment elevation AMI.