title: Comparison of primary angioplasty with conservative therapy in patients with acute myocardial infarction and contraindications for thrombolytic therapy. Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Study Group.
abstract: The benefit of primary angioplasty in patients with acute myocardial infarction (AMI) and contraindications for thrombolysis compared to a conservative regimen is still unclear. Out of 5,869 patients with AMI registered by the MITRA trial, 337 (5.7%) patients had at least one strong contraindication for thrombolytic therapy. Out of these 337 patients 46 (13.6%) were treated with primary angioplasty and 276 (86.4%) were treated conservatively. Patients treated conservatively were older (70 years vs. 60 years; P=0.001), had a higher rate of a history with chronic heart failure (14.8% vs. 4.4%; P=0.053), a higher heart rate at admission (86 beats/min vs. 74 beats/min; P=0.001), and a higher prevalence of diabetes mellitus (27.1% vs. 12.8%; P=0.056). Patients treated with primary angioplasty received more often aspirin (91.3% vs. 74.6%; P=0.012), beta-blockers (60.9% vs. 46.1%; P = 0.062), angiotensin converting enzyme (ACE) inhibitors (71.7% vs. 44%; P=0.001), and the so-called optimal adjunctive medication (54.4% vs. 32.3%; P=0.004). Hospital mortality was significantly lower in patients who received primary angioplasty (univariate: 2.2% vs. 24.7%; P=0.001; multivariate: OR=0.46; P=0.0230). In patients with AMI and contraindications for thrombolytic therapy, primary angioplasty was associated with a significantly lower mortality compared to conservative treatment. Therefore, hospitals without the facilities to perform primary angioplasty should try to refer such patients to centers with the facilities for such a service, if this is possible in an acceptable time.
authors.affiliation: Department of Cardiology, Herzzentrum Ludwigshafen, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Zahn
authors.forename: S
authors.initials: S
authors.lastname: Schuster
authors.forename: R
authors.initials: R
authors.lastname: Schiele
authors.forename: K
authors.initials: K
authors.lastname: Seidl
authors.forename: T
authors.initials: T
authors.lastname: Voigtländer
authors.forename: J
authors.initials: J
authors.lastname: Meyer
authors.forename: K E
authors.initials: KE
authors.lastname: Hauptmann
authors.forename: M
authors.initials: M
authors.lastname: Gottwik
authors.forename: G
authors.initials: G
authors.lastname: Berg
authors.forename: T
authors.initials: T
authors.lastname: Kunz
authors.forename: U
authors.initials: U
authors.lastname: Gieseler
authors.forename: M
authors.initials: M
authors.lastname: Jakob
authors.forename: J
authors.initials: J
authors.lastname: Senges
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002986:Clinical Trials as Topic; D000075202:Contraindications; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D016896:Treatment Outcome