Thrombolysis or primary angioplasty? Reperfusion therapy for myocardial infarction in the UK

Intravenous thrombolysis and percutaneous coronary intervention (PCI) are alternative treatment options for coronary reperfusion in acute myocardial infarction. Recent trials and meta-analyses have produced increasing evidence that primary coronary intervention produces better long-term outcomes for the treatment of acute myocardial infarction. Most of these studies, however, were performed in US or European healthcare systems and may not be directly transferable to an NHS setting. The widespread introduction of primary PCI would have major implications for the organisation of healthcare provision within the UK. An alternative to PCI that may produce similar outcomes at a reduced cost might be early (pre-hospital) administration of thrombolysis. In an era of unprecedented financial attention, the importance of interventions that are simultaneously beneficial to the patient and economical to the NHS has never been more important. The evidence base for primary PCI and its possible use in the NHS are discussed.