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Primary Angioplasty or Thrombolysis
Submit responseCongratulations to Drs. Brophy and Bogaty for their call for restraint from the consideration of primary angioplasty as "the sole or even main treatment option" for acute myocardial infarction. I am the sole internist practicing in a rural community of 16,000 located 130 miles from the nearest cardiac catheterization laboratory. Over the past year or so, I have observed the dramatic change in the management of AMI at our hospital. Currently, our ER physicians arrange for emergency air transportation of AMI patients directly from the emergency room irrespective of timing considerations rather than administering thrombolytic therapy. The hospital, in response, has proposed closure of our 4 bed cardiac care unit. Past success in managing AMI with thrombolytic therapy has left me the sole voice in encouraging restraint until further studies can confirm the conclusion that primary angioplasty is the treatment of choice for our isolated rural patients. In the meantime, I plan to continue to treat patients who are appropriate candidates with thrombolysis, reserving transfer for angioplasty for those patients "who have contraindications to thrombolysis, are at high risk for bleeding, have hemodynamic compromise, or have a large infarction with the possibility of rapid angioplasty."
Conflict of Interest:
None declared