12 THERAPY Angioplasty preferable to thrombolysis in acute MI?

'If a skilled cardiologist is readily available and the patient can be treated rapidly, angioplasty may be preferable' to thrombolysis in the treatment of acute myocardial infarction (MI), report the GUSTO IIb* Angioplasty Substudy Investigators.

In this substudy of the GUSTO lIb study, patients who presented within 12 hours after the onset of symptoms (chest pain lasting ~ 20 minutes accompanied by ST-segment elevation in ~ 2 contiguous leads or left bundle branch block) were randornised to receive angioplasty (n = 573) or accelerated alteplase [t-PA] (565). A subset of patients who underwent angioplasty also received heparin or desirudin.

Benefit at 30 days' post-MI At 30 days' post-MI, the incidence of death,

reinfarction or disabling stroke was significantly lower among angioplasty, compared with alteplase, recipients (9.6 vs 13.7%, respectively).

At 6 months, there was no significant between-group difference in the incidence of death, reinfarction or disabling stroke (13.3% among angioplasty recipients compared with 15.7% among alteplase recipients).

Angioplasty, compared with alteplase, recipients experienced more bleeding events. However, the incidence of intracranial haemorrhage was lower among angioplasty, compared with alteplase, recipients.

While acknowledging that in some situations angioplasty may have advantages over thrombolysis in acute MI, the researchers note that in most situations 'thrombolytic therapy should still be regarded as an excellent strategy of reperfusion ' and they emphasise that the 'important point is not to delay in restoring myocardial reperfusion in suitable candidates with two attractive alternatives'. * GInbal Use of Strategies To Open Occluded Coronary Arteries in Acute Coronary Syndromes lIb The Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTOIIb) Angioplasty Substudy Investigators. A clinicallrial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. New England Journal of Medicine 336: 1621-1628, 5 Jun 1997 """'8081

Inpharma·14 Jun 1997 No. 1091 1173-8324197/1091-000121$01 .oao Adi. International Limited 1997. All rights reserved