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Title: Primary percutaneous coronary inten/ention versus thrombolytic therapy in patients with acute myocardial infarction. Comparison of early and longterm results

Jakub Foryś, Maria Krzemińska-Pakuła, Jan Zbigniew Peruga, Tomasz Bendinger, Piotr Lipiec, Michał Kidawa, Jarosław D. Kasprzak
Original articles
Polish Journal of Cardiology
Start page:
Final page:
primary angioplasty, thrombolysis, myocardial infarction, outcomes

Introduction: Several trials suggest that percutaneous coronary inten/ention (pPCI) may be morę effective than thrombolytic therapy in acute myocardial infarction (AMI). However, whetherthese effectsare sustained in longterm follow-up in population of unselected patients remains uncertain. Aim of study: In ourstudy we compared the efficacyand safety of primary PCI and thrombolysis (TL) in AMI duringa in-hospital and 18-months follow-up period. Materiał and methods: Ourstudy included 1155 patients, 805 consecutive patients were enrolled to PCI group between 06.2001 and 12.2002 and the outcomeswere compared with 350 consecutive patients whoweretreated with TLbetween 01.1998 and 05.2001. The followingendpo-ints were defined: death, reinfarction, stroke or composite endpoints and were assessed at discharge, 30 days and 18 months. Results: In-hospital mortality ratę was 4.1% in PCI group and 7.4% in patients assigned to thrombolytic therapy (p=0.026). Adverse clinical events were morę commoninTL group, includingnonfatal reinfarction, stroke and bleedings. Nonfatal reinfarctionsoccurred in 1.7% of the PCI-treated patients and 4.3% of the patients treated with TL (p=0.011). Stroke manifested itself in 0.25% of the PCI-treated and 2.8% of thrombolitycally treated patients (p=0.0002). The composite hard endpoint (END 1), defined as an incidence of: death, reinfarction orcerebral stroke, occurred in 7% of invasively treated and 15.4% of pharmacologically treated patients (p<0.0001). The composite total endpoint (END 2), which represen-ted an incidence of death, reinfarction, cerebral stroke orrecurrent coronary revascularization (both percutaneous and surgical), occurred in 7.1% of the PCI-treated patients and in 20.8% of the patients treated with TL. At a longterm follow-up of 18 months on average, the mortality ratę was 9.1% in the group treated with the primary coronary angioplasty and 13.7% in the thrombolytically treated group (p=0.013). Myocardial infarction recurred in 4.8% patients in the PCI group and in 6.8% TL treated patients (p=0.21). The incidence of stroke in the PCI group was 1.4% and 4.8% intheTL group (p=0.0008).The END 1 occurred significantly morę oftenin the group treated thrombolytically (14.5% vs 22.3%; p=0.0017) during long-term follow-up. The END 2 occurred in 18.3% of PCI patients and in 30.8% of TL treated ones (p=0.0001). Conclusions: Our findings indicate that primary PCI offers significant advantages over thrombolytic therapy regarding mortality and short-term major adverse cardiac events, such as nonfatal reinfarction, stroke, hemorrhagic complications or composite endpoints in studied population. The benefits of PCI are sustained during long-term follow-up.