August 20, 2003Open Access

A Comparison of Coronary Angioplasty with Fibrinolytic Therapy in Acute Myocardial Infarction

Key Result

Primary angioplasty is superior to on-site fibrinolysis in acute myocardial infarction if transfer to the treatment center takes two hours or less.

Structured PICO

Does primary angioplasty (including interhospital transfer) reduce the composite of death, reinfarction, or disabling stroke in patients with acute ST-segment elevation myocardial infarction compared to on-site fibrinolysis?

Population

1572 patients with acute myocardial infarction with ST-segment elevation (symptoms for ≥30 minutes but <12 hours, ST-segment elevation ≥4 mm in ≥2 contiguous leads)

Intervention

Primary angioplasty (including transfer to an invasive-treatment center within 3 hours if admitted to a referral hospital) plus aspirin 300 mg IV, beta-blocker, and unfractionated heparin

Comparator

Fibrinolysis with accelerated alteplase (15-mg bolus, 0.75 mg/kg over 30 min, 0.5 mg/kg over 60 min) plus aspirin 300 mg orally, beta-blocker, and unfractionated heparin

Outcome

Composite of death from any cause, clinical reinfarction, or disabling stroke at 30 dayscomposite

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

A strategy for reperfusion involving the transfer of patients to an invasive-treatment center for primary angioplasty is superior to on-site fibrinolysis, provided that the transfer takes two hours or less.

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Discussion

Journals

New England Journal of Medicine

Institutions

Rigshospitalet

Aarhus University Hospital

Odense University Hospital

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