Should primary percutaneous coronary intervention be the preferred method of reperfusion therapy for patients with renal failure and ST-elevation acute myocardial infarction?
Data from patients who had ST-elevation acute myocardial infarction and renal failure and were enrolled in the 2002 Acute Coronary Syndrome Israeli Survey (ACSIS) were studied to determine the effect of different myocardial reperfusion modalities on short- and long-term outcomes. Thirty-day crude mortalities were 8.3% in the thrombolysis group, 40.0% in the primary percutaneous coronary intervention group, and 29.7% in the no-reperfusion group (p = 0.03). Crude and adjusted mortality odds ratios that were observed at 7, 30, and 365 days, with the thrombolysis group as the reference, were 3.1 to 8.1 in the percutaneous coronary intervention group and 1.5 to 4.6 in the no-reperfusion group. Our results suggest that thrombolysis may represent the preferred modality of reperfusion therapy in patients with renal failure and ST-elevation acute myocardial infarction. A large randomized prospective study is needed to confirm these results.
Dragu
Robert
R
Intensive Cardiac Care Unit, Rambam Medical Center, Haifa, Israel. dragu@tx.technion.ac.il
Behar
Solomon
S
Sandach
Amir
A
Boyko
Valentina
V
Kapeliovich
Michael
M
Rispler
Shmuel
S
Hammerman
Haim
H
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006306:Health Surveys; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D015425:Myocardial Reperfusion; D010359:Patient Readmission; D010960:Plasminogen Activators / Q000627:therapeutic use; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications*; D013300:Streptokinase / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D013300:Streptokinase; D010960:Plasminogen Activators