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17 August 2004 | Volume 141 Issue 4 | Pages 292-297
Primary angioplasty is increasingly being advocated as the preferred approach for treating acute ST-segment elevation myocardial infarction regardless of whether interinstitutional transfer is required. This review critically analyzes the evidence comparing primary angioplasty with thrombolytic therapy and concludes that reasonable health care professionals may still find considerable uncertainty about the superiority of primary angioplasty for all situations. The magnitude of benefit for primary angioplasty over thrombolysis is probably less than 1 to 2 lives saved/100 patients treated and largely depends on the choice of thrombolytic agent, time to treatment, place of treatment, and adjunctive therapy. There is little evidence that systematically transferring patients for primary angioplasty in routine practice will provide any health benefits over thrombolysis. Consequently, it may be most useful to view these treatments as complementary rather than competitive. Thrombolysis remains a clinically and economically attractive option for the treatment of acute myocardial infarction that does not require the radical restructuring of our health care systems.
Author and Article Information
From McGill University Health Centre, McGill University, Montreal, and the Quebec Heart Institute, Laval University, Quebec City, Quebec, Canada.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: James Brophy, MD, PhD, Divisions of Cardiology and Clinical Epidemiology, Room R4.12, McGill University Health Centre, Royal Victoria Hospital, 687 Pine Street West, Montreal, Quebec H3A 1A1, Canada; e-mail, james.brophy{at}mcgill.ca.
Current Author Addresses: Dr. Brophy: Divisions of Cardiology and Clinical Epidemiology, Room R4.12, McGill University Health Centre, Royal Victoria Hospital, 687 Pine Street West, Montreal, Quebec H3A 1A1, Canada.
Dr. Bogaty: Quebec Heart Institute, Laval Hospital, 2725 Chemin Ste-Foy, Ste-Foy, Quebec G1V 4G5, Canada. IN THE BALANCE
Primary Angioplasty and Thrombolysis Are Both Reasonable Options in Acute Myocardial Infarction
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