Amanda Carver of Queensland Health, Brisbane and colleagues reported that primary percutaneous coronary intervention (PCI) is now the preferred option in patients with ST-segment elevation MI.
Thrombolysis, however, is still used as first-line treatment in about one third of patients for variety of reasons. Inadequate flow is seen in about 40% of this group.
To support this finding the researchers studied data on 427 such patients who had been randomized to receive repeat lysis, conservative treatment or rescue PCI.
Event-free survival for rescue PCI at 1 year was 81.5% compared with 64.1% for repeat thrombolysis and 67.5% for conservative therapy. The adjusted hazard ratio for overall mortality in the PCI group over a median of 4.4 years was 0.41 compared to repeat thrombolysis, and 0.43 compared to conservative therapy.
Commenting on the findings, Dr. Adnan Kastrati, co-author of an accompanying editorial, told Reuters Health that if the first mistake was made to treat patients with acute myocardial infarction with thrombolysis instead of primary angioplasty, we should at least avoid the second mistake of depriving these patients of the durable benefits of rescue angioplasty.
In fact, concluded Dr. Kastrati of Deutsches Herzzentrum, Munich, all patients with acute myocardial infarction who have been treated with thrombolysis should undergo expedited coronary angiography to identify and treat the frequent failures of this old-fashioned therapy.
