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Editorial |

Primary Percutaneous Coronary Intervention for All?

Christopher P. Cannon, MD
JAMA. 2002;287(15):1987-1989. doi:10.1001/jama.287.15.1987.
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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.

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