The primary angioplasty vs thrombolysis debate

Early and complete coronary reperfusion can improve survival in myocardial infarction. Primary angioplasty can achieve TIMI grade 3 flow (complete restoration) in over 90% of cases. In comparison thrombolysis can achieve TIMI grade 3 flow in only just over 50%. Comparative trials have shown superior rates of death and reinfarction with a low haemorrhagic risk with PTCA compared with thrombolysis. Early clinical trials showed a clear superiority of primary angioplasty over thrombolysis but larger trials with larger number of endpoints have shown less impressive superiority. Wider application in community studies has not shown the benefits promised in the earlier studies, possibly due to dilution of experience. The impact of newer stent regimens vs nonnewer thrombolytic and antithrombotic regimens can only be determined by further clinical trials.