Randomized comparison of primary coronary angioplasty with thrombolytic therapy in low risk patients with acute myocardial infarction.
OBJECTIVE
We sought to compare primary coronary angioplasty and thrombolysis as treatment for low risk patients with an acute myocardial infarction.


BACKGROUND
Primary coronary angioplasty is the most effective reperfusion therapy for patients with acute myocardial infarction; however, intravenous thrombolysis is easier to apply, more widely available and possibly more appropriate in low risk patients.


METHODS
We stratified 240 patients with acute myocardial infarction at admission according to risk. Low risk patients (n = 95) were randomized to primary angioplasty or thrombolytic therapy. The primary end point was death, nonfatal stroke or reinfarction during 6 months of follow-up. Left ventricular ejection fraction and medical charges were secondary end points. High risk patients (n = 145) were treated with primary angioplasty.


RESULTS
In low risk patients, the incidence of the primary clinical end point (4% vs. 20%, p < 0.02) was lower in the group with primary coronary angioplasty than in the group with thrombolysis, because of a higher rate of reinfarction in the latter group. Mortality and stroke rates were low in both treatment groups. There were no differences in left ventricular ejection fraction or total medical charges. High risk patients had a 14% incidence rate of the primary clinical end point.


CONCLUSIONS
Simple clinical data can be used to risk-stratify patients during the initial admission for myocardial infarction. Even in low risk patients, primary coronary angioplasty results in a better clinical outcome at 6 months than does thrombolysis and does not increase total medical charges.
Zijlstra
F
F
Department of Cardiology, Hospital De Weezenlanden, Zwolle, The Netherlands.
Beukema
W P
WP
van 't Hof
A W
AW
Liem
A
A
Reiffers
S
S
Hoorntje
J C
JC
Suryapranata
H
H
de Boer
M J
MJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D013300:Streptokinase / Q000627:therapeutic use; D013318:Stroke Volume; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D013300:Streptokinase