title: Primary angioplasty versus thrombolysis in the treatment of acute myocardial infarction. ALKK Study Group.
abstract: This study investigates the hypothesis if primary angioplasty is superior to intravenous thrombolysis in the treatment of acute myocardial infarction (AMI). Small prospective randomized studies did not demonstrate a significant benefit regarding total mortality. A total of 14,980 patients with AMI were registered by "The 60-Minutes Myocardial Infarction Project," a prospective multicenter observational study: 210 of these patients were treated with primary angioplasty. A matched pair analysis comparing 1 primary angioplasty patient with 3 intravenous thrombolysis patients could be performed in 156 primary angioplasty patients. Criteria for matching were age, sex, location of AMI, systolic blood pressure, previous AMI, and prehospital delay. Patients with a bundle branch block or requiring resuscitation were excluded from analysis. Because of matching, both groups showed similar baseline characteristics. Patients with primary angioplasty had more relative contraindications for thrombolysis (ulcers: 10.3% vs 2.3%, recent intramuscular injections: 6.4% vs 1.6%, recent surgical interventions: 5.1% vs 1.1%, central punctures: 9% vs 3.9%). There was a tendency toward less combined adverse events in the primary angioplasty group (3.2% vs 5.7%, odds ratio [OR] = 0.55, 95% confidence interval [CI] = 0.21 to 1.44). In-hospital mortality rates in the primary angioplasty group and thrombolysis group were 4.3% and 10.3%, respectively (OR = 0.39, 95% CI = 0.17 to 0.92). The difference in mortality could already be demonstrated within the first 48 hours with 1.9% versus 5.3% deaths (OR = 0.35, 95% CI = 0.11 to 1.14). Thus this study indicates a superiority of primary angioplasty in comparison to intravenous thrombolysis in AMI even in a clinical routine setting, with a reduction of hospital mortality of about 60%.
authors.affiliation: Herzzentrum Ludwigshafen, Kardiologie, Ludwigshafen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Zahn
authors.forename: A
authors.initials: A
authors.lastname: Koch
authors.forename: J
authors.initials: J
authors.lastname: Rustige
authors.forename: R
authors.initials: R
authors.lastname: Schiele
authors.forename: A
authors.initials: A
authors.lastname: Wirtzfeld
authors.forename: K L
authors.initials: KL
authors.lastname: Neuhaus
authors.forename: H
authors.initials: H
authors.lastname: Kuhn
authors.forename: H
authors.initials: H
authors.lastname: Gülker
authors.forename: J
authors.initials: J
authors.lastname: Senges
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D016896:Treatment Outcome