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Management comparison for acute myocardial infarction: direct angioplasty versus sequential thrombolysis-angioplasty
G D Beauchamp1, J L Vacek, W Robuck
1Mid America Heart Institute, St. Luke's Hospital, Kansas City, Mo.
Insights
For acute myocardial infarction, initial thrombolytic therapy followed by angioplasty improved survival rates compared to direct angioplasty. Both methods achieved high recanalization, but the combined approach offered better short- and long-term outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- Acute myocardial infarction (AMI) management strategies aim to restore coronary blood flow.
- Percutaneous transluminal coronary angioplasty (PTCA) and thrombolytic therapy are key reperfusion treatments for AMI.
Purpose of the Study:
- To compare the efficacy and outcomes of early direct PTCA versus initial thrombolytic therapy followed by PTCA in AMI patients.
- To evaluate recanalization rates, in-hospital survival, and 1-year survival for both management approaches.
Main Methods:
- Retrospective analysis of 214 AMI patients treated between 1982 and 1989.
- Group A: Early direct PTCA (within 6 hours of onset).
- Group B: Initial thrombolytic therapy (streptokinase or t-PA) followed by PTCA.
Main Results:
- Successful reperfusion rates were high for both groups (92.1% direct PTCA, 94.3% after thrombolysis).
- In-hospital and 1-year survival rates were significantly better in Group B (95.5%) compared to Group A (92.1% and 89.3%, respectively).
- No significant difference in patency rates was observed between streptokinase and t-PA.
Conclusions:
- Both direct PTCA and thrombolytic therapy followed by PTCA are effective in achieving coronary recanalization in AMI.
- Initial thrombolytic therapy preceding angioplasty is associated with improved short- and long-term survival in AMI patients.
Abstract:
To compare the results and outcome of different management approaches for acute myocardial infarction, we analyzed our experience with early (i.e., within 6 hours of infarct onset) direct percutaneous transluminal coronary angioplasty (group A) versus initial treatment with thrombolytic therapy (group B) followed by angioplasty. From 1982 to 1989 a total of 214 patients underwent primary angioplasty for acute myocardial infarction. During this time 157 patients underwent initial thrombolytic therapy, 104 with intravenous streptokinase and 53 with intravenous tissue-type plasminogen activator followed by angioplasty. Other than age (group A, 61.7 +/- 11.5 years; group B, 57.3 +/- 11.6 years; p = 0.0002), the clinical characteristics of the groups were similar. In group A, 197 (92.1%) had successful results, and 17 (7.9%) were failures. Of the group treated with thrombolytic therapy, there was an overall 81.5% patency rate for patients treated with streptokinase and tissue-type plasminogen activator with no significant difference between the agents. Angioplasty success after thrombolytic therapy was 94.3%. In-hospital and 1-year survival was significantly better in group B patients (95.5% and 95.5%, respectively) than in group A patients (92.1% and 89.3%, respectively). We conclude that both direct angioplasty and thrombolytic therapy followed by angioplasty provide high recanalization rates but that short- and long-term survival is improved when thrombolytic therapy precedes angioplasty in acute myocardial infarction patients.