Key result
Primary percutaneous coronary intervention reduced 30-day mortality compared to thrombolytic therapy in patients with anterior wall MI (2% vs. 6.3%; P=0.04).
Why the study?
Does primary PCI reduce 30-day mortality compared to thrombolytic therapy in patients with anterior wall myocardial infarction without cardiogenic shock?
Observational (n=1,038)
Yes
Does primary PCI reduce 30-day mortality compared to thrombolytic therapy in patients with anterior wall myocardial infarction without cardiogenic shock?
In real-world practice, primary PCI significantly reduces 30-day mortality compared to thrombolytic therapy in patients with anterior wall MI without cardiogenic shock, particularly in those under 75 years of age.
Answers are grounded in this paper and cite their sources.
May favor primary PCI in anterior MI without shock; hypothesis-generating and requires randomized confirmation.
Some prospective randomized trials have established the superiority of primary percutaneous coronary intervention (PCI) over fibrinolytic treatment in patients with acute myocardial infarction (MI). These excellent PCI results are not duplicated in smaller hospitals where there may be delays in getting the cardiac catheterization team to the laboratory. This study aimed to compare the outcome of patients with anterior wall MI, without cardiogenic shock on admission, treated with primary PCI or thrombolytic therapy, in everyday practice. The data of all patients with MI hospitalized in all coronary care units operating in Israel during three consecutive national surveys was analyzed. A total of 1,038 patients with anterior wall MI were treated by reperfusion (886 received thrombolytic therapy, 152 primary PCI). Overall, the outcome of patients treated using primary PCI was better compared to patients treated with thrombolysis, with 68% relative risk reduction of 30-day mortality (mortality at 30 days: 2% vs. 6.3%; P = 0.04). A subanalysis of patients according to age showed that the beneficial effect of primary PCI on mortality was mainly clustered among the younger. In our study, patients (especially younger than 75 years) with anterior wall MI allocated to primary PCI have a better clinical outcome.
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Solodky et al. (2003) conducted an observational in Anterior wall myocardial infarction (n=1,038). Primary percutaneous coronary intervention (PCI) vs. Thrombolytic therapy was evaluated on 30-day mortality (RRR 68%, p=0.04). Primary percutaneous coronary intervention reduced 30-day mortality compared to thrombolytic therapy in patients with anterior wall MI (2% vs. 6.3%; P=0.04).
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