0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
In the Balance |

Primary Angioplasty and Thrombolysis Are Both Reasonable Options in Acute Myocardial Infarction

James M. Brophy, MD, PhD; and Peter Bogaty, MD
[+] Article and Author Information

From McGill University Health Centre, McGill University, Montreal, and the Quebec Heart Institute, Laval University, Quebec City, Quebec, Canada.


Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: James Brophy, MD, PhD, Divisions of Cardiology and Clinical Epidemiology, Room R4.12, McGill University Health Centre, Royal Victoria Hospital, 687 Pine Street West, Montreal, Quebec H3A 1A1, Canada; e-mail, james.brophy@mcgill.ca.

Current Author Addresses: Dr. Brophy: Divisions of Cardiology and Clinical Epidemiology, Room R4.12, McGill University Health Centre, Royal Victoria Hospital, 687 Pine Street West, Montreal, Quebec H3A 1A1, Canada.

Dr. Bogaty: Quebec Heart Institute, Laval Hospital, 2725 Chemin Ste-Foy, Ste-Foy, Quebec G1V 4G5, Canada.


Ann Intern Med. 2004;141(4):292-297. doi:10.7326/0003-4819-141-4-200408170-00009
Text Size: A A A

Primary angioplasty is increasingly being advocated as the preferred approach for treating acute ST-segment elevation myocardial infarction regardless of whether interinstitutional transfer is required. This review critically analyzes the evidence comparing primary angioplasty with thrombolytic therapy and concludes that reasonable health care professionals may still find considerable uncertainty about the superiority of primary angioplasty for all situations. The magnitude of benefit for primary angioplasty over thrombolysis is probably less than 1 to 2 lives saved/100 patients treated and largely depends on the choice of thrombolytic agent, time to treatment, place of treatment, and adjunctive therapy. There is little evidence that systematically transferring patients for primary angioplasty in routine practice will provide any health benefits over thrombolysis. Consequently, it may be most useful to view these treatments as complementary rather than competitive. Thrombolysis remains a clinically and economically attractive option for the treatment of acute myocardial infarction that does not require the radical restructuring of our health care systems.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Primary Angioplasty or Thrombolysis
Posted on September 20, 2004
Charles E. Hofmann
none
Conflict of Interest: None Declared

Congratulations to Drs. Brophy and Bogaty for their call for restraint from the consideration of primary angioplasty as "the sole or even main treatment option" for acute myocardial infarction. I am the sole internist practicing in a rural community of 16,000 located 130 miles from the nearest cardiac catheterization laboratory. Over the past year or so, I have observed the dramatic change in the management of AMI at our hospital. Currently, our ER physicians arrange for emergency air transportation of AMI patients directly from the emergency room irrespective of timing considerations rather than administering thrombolytic therapy. The hospital, in response, has proposed closure of our 4 bed cardiac care unit. Past success in managing AMI with thrombolytic therapy has left me the sole voice in encouraging restraint until further studies can confirm the conclusion that primary angioplasty is the treatment of choice for our isolated rural patients. In the meantime, I plan to continue to treat patients who are appropriate candidates with thrombolysis, reserving transfer for angioplasty for those patients "who have contraindications to thrombolysis, are at high risk for bleeding, have hemodynamic compromise, or have a large infarction with the possibility of rapid angioplasty."

Conflict of Interest:

None declared

Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)