Inpharma 1356 - 21 Sep 2002 Primary angioplasty superior in acute MI The best treatment strategy for most patients with evolving acute myocardial infarction (MI) is to ‘administer antiplatelet therapy (aspirin, a thienopyridine and possibly abciximab), withhold thrombolytic therapy, and transfer the patient for primary PTCA [percutaneous transluminal coronary angioplasty]’, says Dr Gregg Stone from the Cardiovascular Research Foundation, New York City, US. 1 Dr Stone’s comment is in reference to the CAPTIM trial, which compared the efficacy of PTCA and prehospital fibrinolysis in 840 patients with acute MI. 2 The main results of this study have previously been reported. * According to Dr Stone, it is time for a ‘wake- up call’ in the ongoing debate concerning the best reperfusion therapy for the treatment of patients with acute MI. 1 In the CAPTIM trial, PTCA, compared with fibrinolysis, was associated with a trend towards a 24% relative reduction in the occurrence of adverse events, due to large reductions in reinfarction and stroke, says Dr Stone. Various other clinical trials have also shown that, compared with thrombolytic therapy, PTCA results in higher rates of patency of the infarct-related artery as well as reduced rates of death, reinfarction, recurrent ischaemia, unplanned revascularisation procedures, stroke and intracerebral bleeding, says Dr Stone. Rates of early hospital discharge and myocardial salvage have also been found to be greater with PTCA, compared with thrombolytic therapy, he adds. Critics of the technique maintain that PTCA results in excessive delays to treatment compared with thrombolytic therapy and that the technique is only available in a few hospitals. Dr Stone responds by saying that the fact that PTCA has been associated with increased survival rates, despite unavoidable delays in mobilising surgical teams, attests to the more complete reperfusion and mitigation of stroke using this technique. He also notes that recent studies have proven the greater efficacy of PTCA , compared with thrombolytic therapy, even in community hospitals. Dr Stone goes on to say that there is increasing interest in the use of ‘facilitated angioplasty’, an approach that combines pharmacological reperfusion with invasive revascularisation. However, he comments that although it is possible that earlier reperfusion may further improve outcomes, the superiority of this technique over primary PTCA alone has yet to be proven. Dr Stone concludes that, until further data are available, primary PTCA is the superior method of reperfusion for patients with evolving acute MI. ‘To do less should no longer be considered standard care’, he adds. * see Inpharma 1306: 11–12, 22 Sep 2001; 800840791 1. Stone GW. Primary angioplasty versus earlier thrombolysis - time for a wake-up call. Lancet 360: 814-816, 14 Sep 2002. 2. Bonnefoy E, et al. Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study. Lancet 360: 825-829, 14 Sep 2002. 800888566 1 Inpharma 21 Sep 2002 No. 1356 1173-8324/10/1356-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

Primary angioplasty superior in acute MI

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Inpharma 1356 - 21 Sep 2002

Primary angioplasty superior inacute MI

The best treatment strategy for most patients withevolving acute myocardial infarction (MI) is to‘administer antiplatelet therapy (aspirin, a thienopyridineand possibly abciximab), withhold thrombolytic therapy,and transfer the patient for primary PTCA [percutaneoustransluminal coronary angioplasty]’, says Dr GreggStone from the Cardiovascular Research Foundation,New York City, US.1

Dr Stone’s comment is in reference to the CAPTIMtrial, which compared the efficacy of PTCA andprehospital fibrinolysis in 840 patients with acute MI.2The main results of this study have previously beenreported.* According to Dr Stone, it is time for a ‘wake-up call’ in the ongoing debate concerning the bestreperfusion therapy for the treatment of patients withacute MI.1

In the CAPTIM trial, PTCA, compared with fibrinolysis,was associated with a trend towards a 24% relativereduction in the occurrence of adverse events, due tolarge reductions in reinfarction and stroke, says DrStone. Various other clinical trials have also shown that,compared with thrombolytic therapy, PTCA results inhigher rates of patency of the infarct-related artery aswell as reduced rates of death, reinfarction, recurrentischaemia, unplanned revascularisation procedures,stroke and intracerebral bleeding, says Dr Stone. Ratesof early hospital discharge and myocardial salvage havealso been found to be greater with PTCA, compared withthrombolytic therapy, he adds.

Critics of the technique maintain that PTCA results inexcessive delays to treatment compared withthrombolytic therapy and that the technique is onlyavailable in a few hospitals. Dr Stone responds by sayingthat the fact that PTCA has been associated withincreased survival rates, despite unavoidable delays inmobilising surgical teams, attests to the more completereperfusion and mitigation of stroke using thistechnique. He also notes that recent studies haveproven the greater efficacy of PTCA , compared withthrombolytic therapy, even in community hospitals.

Dr Stone goes on to say that there is increasinginterest in the use of ‘facilitated angioplasty’, anapproach that combines pharmacological reperfusionwith invasive revascularisation. However, he commentsthat although it is possible that earlier reperfusion mayfurther improve outcomes, the superiority of thistechnique over primary PTCA alone has yet to beproven.

Dr Stone concludes that, until further data areavailable, primary PTCA is the superior method ofreperfusion for patients with evolving acute MI. ‘To doless should no longer be considered standard care’, headds.* see Inpharma 1306: 11–12, 22 Sep 2001; 800840791

1. Stone GW. Primary angioplasty versus earlier thrombolysis - time for a wake-upcall. Lancet 360: 814-816, 14 Sep 2002.

2. Bonnefoy E, et al. Primary angioplasty versus prehospital fibrinolysis in acutemyocardial infarction: a randomised study. Lancet 360: 825-829, 14 Sep 2002.

800888566