Predictors of in-hospital and 6-month outcome after acute myocardial infarction in the reperfusion era: The primary angioplasty in myocardial infarction (PAMI) trial
Why the study?
The optimal reperfusion strategy for acute myocardial infarction remained controversial, and predictors of outcome in the reperfusion era had been incompletely characterized.
Does primary angioplasty reduce mortality and reinfarction compared to t-PA in patients with acute transmural myocardial infarction?
Population
395 patients presenting within 12 h of onset of acute transmural myocardial infarction at 12 centers
Comparison
Primary angioplasty without antecedent thrombolysis vs t-PA
Design
Prospective randomized trial
Follow-up
6-month
Key result
Primary angioplasty significantly reduced in-hospital mortality compared to t-PA (2.6% vs. 6.5%, p=0.039) in patients with acute transmural myocardial infarction.
Authors
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Captured external expert commentary on this paper, strongest first. Original sources linked on every quote.
“It's not time for all of us to change our practice.”
“Two years ago in a head-to-head comparison [in PAMI-1] we found that mortality with tPA was 6.5 percent and with angioplasty it was 2.5 percent.”
Primary angioplasty is superior to thrombolytic therapy with t-PA in reducing in-hospital mortality, reinfarction, and recurrent ischemia in patients with acute myocardial infarction, with benefits maintained at 6 months.
RCT (n=395)
Yes
Does primary angioplasty reduce mortality and reinfarction compared to t-PA in patients with acute transmural myocardial infarction?
Primary angioplasty is superior to thrombolytic therapy with t-PA in reducing in-hospital mortality, reinfarction, and recurrent ischemia in patients with acute myocardial infarction, with benefits maintained at 6 months.
Absolute Event Rate: 2.6% vs 6.5%
p-value: p=0.039
Stone et al. (1995) conducted an RCT in Acute transmural myocardial infarction (n=395). Primary angioplasty vs. Tissue-type plasminogen activator (t-PA) was evaluated on In-hospital mortality (p=0.039). Primary angioplasty significantly reduced in-hospital mortality compared to t-PA (2.6% vs. 6.5%, p=0.039) in patients with acute transmural myocardial infarction.