Primary angioplasty reduced 30-day death, reinfarction, and stroke compared to thrombolysis across early (5.8% vs 12.5%), intermediate (8.6% vs 14.2%), and late (7.7% vs 19.4%) presentations.
Meta-Analysis (n=2,635)
Yes
Does primary coronary angioplasty reduce major adverse cardiac events compared to thrombolytic therapy in patients with acute myocardial infarction across different presentation time delays?
Primary angioplasty is associated with lower rates of major adverse cardiac events compared to thrombolysis in acute myocardial infarction, regardless of the time delay from symptom onset to presentation.
AIMS: We examined the clinical characteristics and outcome of patients with early (4 h) presentation treated by primary angioplasty or thrombolytic therapy for acute myocardial infarction. METHODS AND RESULTS: We studied 2635 patients enrolled in 10 randomized trials of primary angioplasty (n=1302) vs thrombolytic therapy (n=1333) in acute myocardial infarction, and baseline characteristics of the two groups were comparable. Increase in presentation delay is associated with older age, female gender, diabetes and an increased heart rate. We classified the patients according to the time delay from symptom onset to presentation into three categories: early presentation (or=4 h). At 30 days the combined rate of death, non-fatal reinfarction and stroke in patients presenting early was 5.8% in the angioplasty group vs 12.5% in the thrombolysis group, in patients with intermediate presentation, 8.6% vs 14.2%, respectively, and in patients presenting late 7.7% vs 19.4%, respectively. With increasing time from symptom onset to presentation, all major adverse cardiac event rates show a trend to a larger increase in the thrombolysis group compared to the angioplasty group, both at 30 days and at 6 months after the acute event. CONCLUSIONS: Major adverse cardiac event rates are lower after angioplasty compared to thrombolysis, irrespective of time to presentation. With increasing time to presentation major adverse cardiac event rates increase after thrombolysis but appear to remain relatively stable after angioplasty.
Felix Zijlstra (Mon,) conducted a meta-analysis in acute myocardial infarction (n=2,635). Primary coronary angioplasty vs. Thrombolytic therapy was evaluated on Combined rate of death, non-fatal reinfarction and stroke at 30 days. Primary angioplasty reduced 30-day death, reinfarction, and stroke compared to thrombolysis across early (5.8% vs 12.5%), intermediate (8.6% vs 14.2%), and late (7.7% vs 19.4%) presentations.
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