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November 4, 1999New England Journal of Medicine

Long-Term Benefit of Primary Angioplasty as Compared with Thrombolytic Therapy for Acute Myocardial Infarction

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Why the study?

Does primary coronary angioplasty reduce mortality and reinfarction in patients with acute myocardial infarction compared to intravenous streptokinase?

Population

395 patients with acute myocardial infarction

Comparison

Primary coronary angioplasty vs Intravenous streptokinase

Design

RCT, Randomly assigned

Follow-up

mean 5+/-2 years

Authors

FZFelix ZijlstraInterventional CardiologyJHJan C.A. HoorntjeInterventional CardiologyMBMenko-Jan de Boer

Discussion

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Implication

Primary angioplasty reduces mortality versus streptokinase in acute MI; confirms mechanical reperfusion superiority for STEMI.

Key Points

  • This research aims to compare the long-term benefits of primary angioplasty to thrombolytic therapy in patients with acute myocardial infarction.
  • 395 patients with acute myocardial infarction were randomly assigned to receive either angioplasty or intravenous streptokinase.
  • Clinical information was collected over a mean follow-up of 5 years.
  • Medical charges associated with each treatment were compared.
  • Mortality was 13% in the angioplasty group versus 24% in the streptokinase group (relative risk 0.54, 95% CI 0.36 to 0.87).
  • Nonfatal reinfarction occurred in 6% of the angioplasty group compared to 22% of the streptokinase group (relative risk 0.27, 95% CI 0.15 to 0.52).
  • Total medical charges were lower in the angioplasty group ($16,090) compared to the streptokinase group ($16,813, P=0.05).

Structured PICO

Does primary coronary angioplasty reduce mortality and reinfarction in patients with acute myocardial infarction compared to intravenous streptokinase?

P
Population
395 patients with acute myocardial infarction
I
Intervention
Primary coronary angioplasty
C
Comparator
Intravenous streptokinase
O
Outcome
Mortality at mean 5 years follow-uphard clinical

Primary coronary angioplasty provides significant long-term mortality and morbidity benefits over intravenous streptokinase for acute myocardial infarction.

Cite This Study

Zijlstra et al. (1999) studied this question.

synapsesocial.com/papers/69f29d581b51e2fbf0187555https://doi.org/10.1056/nejm199911043411901
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Danish Multicenter Randomized Study of Invasive Versus Conservative Treatment in Patients With Inducible Ischemia After Thrombolysis in Acute Myocardial Infarction (DANAMI)1997 · 289 citations
  2. 2Fortnightly review: Secondary prevention in acute myocardial infarction1998 · 52 citations
  3. 3A Comparison of Immediate Coronary Angioplasty with Intravenous Streptokinase in Acute Myocardial Infarction1993 · 1,298 citations
  4. 4Randomized Comparison of Coronary Stenting With Balloon Angioplasty in Selected Patients With Acute Myocardial Infarction1998 · 349 citations
  5. 5Immediate Angioplasty Compared with the Administration of a Thrombolytic Agent Followed by Conservative Treatment for Myocardial Infarction1993 · 818 citations