title: Primary percutaneous angioplasty, thrombolysis and conservative treatment in low-risk patients with ST-elevation myocardial infarction: effects on short- and long-term mortality.
abstract: BACKGROUND
  Although primary coronary intervention (PCI) is currently regarded as the preferred reperfusion strategy in ST- -elevation myocardial infarction (STEMI), its superiority over thrombolysis has been documented mainly in high-risk patients. In low-risk patients, the difference seems to be not so significant.
  
  
  OBJECTIVE
  To evaluate the early and late mortality in low-risk STEMI patients treated with thrombolysis, PCI, or conservatively.
  
  
  METHODS
  From a total of 3,780 consecutive STEMI patients presenting within 24 h from symptom onset, 990 low-risk patients (age < 70 years old, Killip-Kimball class 1 at admission, non-anterior STEMI) were selected. The median follow-up duration was 18.3 (14.2-25.0) months. The patients were subdivided into three groups: group A (n = 465) - treated with PCI; group B (n = 289) - treated with thrombolysis; and group C (n = 236) - treated conservatively.
  
  
  RESULTS
  In the whole study group 12 (1.21%) patients died; 30-day mortality in group A was 0.65%. In group B five out of 289 (1.73%) patients died, and in group C four out of 236 (1.69%) patients died. No significant differences in 30-day mortality between these three groups were found (p = 0.3). During the long-term follow-up, 37 (3.7%) of 990 patients died. In group A 18 (3.9%) patients died, in group B ten (3.4%) patients died, and in group C nine (3.8%) patients died (p = 0.96).
  
  
  CONCLUSIONS
  No significant differences in 30-day or long-term mortality rates between conservative therapy, PCI or thrombolysis groups in low-risk STEMI patients were observed.
authors.affiliation: 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Grajek
authors.forename: Aleksander
authors.initials: A
authors.lastname: Araszkiewicz
authors.forename: Maciej
authors.initials: M
authors.lastname: Lesiak
authors.forename: Marek
authors.initials: M
authors.lastname: Grygier
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Pyda
authors.forename: Włodzimierz
authors.initials: W
authors.lastname: Skorupski
authors.forename: Przemysław
authors.initials: P
authors.lastname: Mitkowski
authors.forename: Artur
authors.initials: A
authors.lastname: Baszko
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000592:standards; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012306:Risk; D015912:Thrombolytic Therapy / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents