PTCA superior to thrombolysis in elderly patients with acute MI?

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<ul><li><p>THERAPY </p><p>PICA superior to thrombolysis in elderly patients with acute MI? </p><p>Primary percutaneous transluminal coronary angioplasty (PTCA) reduces mortality rates compared with thrombolysis in elderly patients with acute myocardial infarction (MI), say researchers in the US. </p><p>In this retrospective cohort analysis, clinical data from the Cooperative Cardiovascular Project were examined. Of 80 356 patients aged ~ 65 years presenting with MI, 18645 received thrombolytic therapy and 2038 patients underwent PTCA within 6 hours of hospital admission. </p><p>Patients treated with PTCA had significantly lower mortality compared to patients given thrombolysis at 30 days (8.7 vs 11.9% of patients, respectively) and at 1 year (14.4 vs 17.6%, respectively). Mortality in the PTCA group remained significantly lower at 18 months' follow-up. </p><p>Adverse events Compared with PTCA, thrombolysis was associ-</p><p>ated with significantly higher in-hospital incidence rates of post-MI angina, reinfarction, cerebral haemorrhage and stroke. Conversely, PTCA-treated patients experienced significantly more haemorrhage and were significantly more likely to undergo coronary artery bypass surgery. </p><p>28 955 patients in the cohort population had ST elevation or left bundle-branch block on initial ECG and were classified as ideal candidates for reperfusion therapy; 12941 received reperfusion therapy within 6 hours of hospital arrival. Although recipients of primary PTCA in this subgroup had a lower 30-day mortality than early thrombolysis recipients (10.1 vs 12% of patients, respectively), the between-group difference in survival was diminished at 1 year (16.2 vs 17.8% of patients, respectively). </p><p>Patients receiving either reperfusion therapy (PTCA or thrombolysis) had significantly lower mortality rates than patients not receiving any reperfusion therapy at both 30 days (11.8 vs 17.2% of patients, respectively) and at 1 year (17.6 vs 33.1 %, respect-ively). </p><p>The researchers stress that 'while an argument can be made for primary PTCA over thrombolysis in the elderly, more attention needs to be focused on the early recognition of AMI [acute MI] in this popu-lation and the rapid delivery of either reperjusion therapy'. </p><p>Berger AI{, Schulman KA, Gersch BJ. Primary coronary angioplasty vs thrombolysis for the management of acute myocardial infarction in elderly patients. Journal of the American Medical Association 282: 341-348, 28 Jull999 </p><p>I007I3&gt;31 </p><p>1173-832419911199-000131$01.00 Adlalntemlltlonal Umlted 1999. All rights reaerved </p><p>13 </p><p>Inphanna-7 Aug 1999 No. 11119 </p></li></ul>