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.

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Inpharma 21 Sep 2002 No. 13561173-8324/10/1356-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved