title: Thrombolysis followed by coronary angiography versus primary percutaneous coronary intervention in non-anterior ST-elevation myocardial infarction.
abstract: BACKGROUND
  Previous studies demonstrated the superiority of primary percutaneous coronary intervention (PCI) over thrombolysis for treatment of ST-elevation myocardial infarction (STEMI); however, this advantage is less evident in low-risk populations. The aim of this study was to assess whether a strategy of thrombolysis followed by routine coronary angiography in patients with non-anterior STEMI is non-inferior to primary PCI.
  
  
  METHODS
  Consecutive patients with non-anterior STEMI presenting within 6 hours of symptom onset who received reperfusion treatment were included. Mortality, infarct size, and in-hospital and long-term major adverse events were compared between patients treated with primary PCI to those who received thrombolysis followed by coronary angiography and intervention as needed.
  
  
  RESULTS
  A total of 300 patients were included: 180 who received thrombolysis and 120 treated with primary PCI. No significant differences were found in mortality, infarct size, or long-term adverse events between groups. Higher rates of in-hospital recurrent ischemic events and longer hospitalization were noted in the thrombolysis group.
  
  
  CONCLUSIONS
  The strategy of thrombolysis followed by routine coronary angiography in non-anterior STEMI patients results in major outcomes similar to primary PCI. Thrombolysis serves as a viable approach for patients presenting with non-anterior STEMI to hospitals without catheterization facilities. The optimal time between thrombolysis and coronary angiography should be within 2 days to avoid recurrent ischemia.
authors.affiliation: Heart institute, Hadassah Hebrew University Medical Center, P.O. Box 12000, Jerusalem, Israel 91120. ronny@hadassah.org.il.
authors.forename: Roy
authors.initials: R
authors.lastname: Schwartz
authors.forename: A Teddy
authors.initials: AT
authors.lastname: Weiss
authors.forename: David
authors.initials: D
authors.lastname: Leibowitz
authors.forename: David
authors.initials: D
authors.lastname: Rot
authors.forename: Arthur
authors.initials: A
authors.lastname: Pollak
authors.forename: Chaim
authors.initials: C
authors.lastname: Lotan
authors.forename: Ronny
authors.initials: R
authors.lastname: Alcalai
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors