Angioplasty favoured over thrombolysis?

Is angioplasty the way of the future for treating acute MI? Three studies in the NEJM [11 Mar 1993 J compare the efficacy of thrombolysis and angioplasty, but do not reach a common conclusion.

In a Dutch study of 142 patients, coronary angioplasty resulted in a higher patency of infarct-related arteries, less severe stenotic lesions, improved left ventricular ejection fraction and a reduced incidence of recurrent myocardial ischaemia, compared with streptokinase I.

These results were consistent with those of the PAMI study (Primary Angioplasty in Myocardial Infarction), which showed a significant benefit of angioplasty over thrombolysis with alteplase, as announced at the American Heart Association conference last year [see Inpharma 866: 15, 5 Dec 1992j2.

Thrombolysis still the treatment of choice

THERAPY

However, a similar study from the Mayo Clinic and Foundation in the US found little difference between angioplasty and thrombolysis , and concluded that thrombolysis was still the treatment of choice because it was easier to administer, and more widely available, than angioplasty3.

Nevertheless, the authors say that angioplasty should be considered as an alternative for patients with contraindications to thrombolysis. Larger trials are needed before it is known whether angioplasty has equal efficacy to thrombolysis in reducing early mortality. 1. Zijlstra F. et a1. A comparison of immediate angioplasty with intravenous streptokinase in acute myocardial infarction. New England Journal of Medicine 328: 680-684. II Mar 1993 2. Grines CL, et a1. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. New England Journal of Medicine 328: 673-679. II Mar 1993 3. Gibbons RJ. et a1. Immediate angioplasty compared with the administration of a thrombolytic agent followed by conservative treatment for myocardial infarction. New England Journal of Medicine 328: 685-691 . II Mar 1993

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~ Editorial comment: In an editorial accompanying these studies, 2 US doctors speakfirmly in/avour o/thrombolytic therapy. For more detail, see p4, this issue.

ISSN 0156-2703/93/0320-0015/$1 .00~ Adls International Ltd

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INPHARMA@20 Mar 1993