PRimary coronary angioplasty versus thrombolytic therapy. Comparison of mortality in the acute phase of myocardial infarction - a single centre experience.

BACKGROUND: Patency of an infarct-related artery may be achieved by the use of primary coronary angioplasty or thrombolysis. In spite of the growing number of reports dealing with this topic, controversies exist as to the superiority of either of these therapeutic options. Moreover, the role of primary angioplasty has not yet been clearly defined in the guidelines of the Polish Cardiac Society. AIM: To compare mortality in the acute phase of myocardial infarction (MI) in patients treated with primary angioplasty versus patients receiving thrombolytic treatment. METHODS: Using prospectively collected data from all consecutive patients with acute MI admitted to our institution, we analysed retrospectively mortality in patients treated with primary angioplasty versus those who received thrombolysis. RESULTS: Between May 1996 and October 2000, 657 patients with acute MI were hospitalised. Of this group, in 66 (10%) patients primary angioplasty was performed, and 278 (42.3%) received thrombolysis. Cardiogenic shock complicated MI in 20 (30%) patients treated with angioplasty and in 19 (7%) thrombolysed patients. Total mortality in the acute phase of MI was 12 (18.2%) patients in the angioplasty group versus 26 (9.4%) patients in the medically treated group (p<0.05). Mortality among patients with cardiogenic shock was significantly higher in those who received thrombolysis than in those who underwent angioplasty [17 (89.5%) patients versus 11 (55%) patients (p<0.05)] and tended to be higher among patients without cardiogenic shock [9 (3%) thrombolysed patients versus 1 (2.2%) patient who underwent angioplasty, NS]. CONCLUSIONS: Primary coronary angioplasty improves the outcome in patients with acute MI complicated by cardiogenic shock and tends to decrease mortality among patients without cardiogenic shock.