Management comparison for acute myocardial infarction: direct angioplasty versus sequential thrombolysis-angioplasty.
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.
Beauchamp
G D
GD
Mid America Heart Institute, St. Luke's Hospital, Kansas City, Mo.
Vacek
J L
JL
Robuck
W
W
D000368:Aged; D000792:Angiography; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D012008:Recurrence; D012086:Reoperation; D013300:Streptokinase / Q000627:therapeutic use; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D013300:Streptokinase; D010959:Tissue Plasminogen Activator