Reperfusion therapy with thrombolysis or primary percutaneous coronary
intervention (PCI) has been a major advance in the treatment of acute ST-segment
elevation myocardial infarction (MI), with a 25% reduction in mortality with
thrombolysis.1 Primary PCI has been considered
in the American College of Cardiology/American Heart Association (ACC/AHA)
guidelines in 1999 to be an alternative to thrombolysis.2
Since then, the number of trials and number of patients randomized has more
than doubled to 21 trials and 6800 patients, all of which show clear benefit
of PCI over thrombolysis. A meta-analysis of the randomized trials carried
out through 1997 showed a clear reduction in mortality, recurrent MI, stroke,
and intracranial hemorrhage. Mortality was reduced a relative 34% (6.5% for
thrombolysis vs 4.4% for primary PCI), suggesting that 20 patients' lives
would be saved for every 1000 patients treated with primary PCI instead of
thrombolytic therapy.3 Nonfatal reinfarction
was reduced nearly 50% (5.3% for thrombolysis and 2.9% for PCI) and intracranial
hemorrhage was essentially eliminated (1.1% with thrombolysis and 0.1% with
PCI).3 In addition, cost appears to be similar
between the 2 strategies,4 largely because
many patients receive PCI following initial thrombolysis. Thus, based on these
initial 10 randomized trials, primary PCI is considered a superior strategy
both for efficacy and safety.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 18
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.