THERAPY
PICA superior to thrombolysis in elderly patients with acute MI?
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.
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.
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.
Adverse events Compared with PTCA, thrombolysis was associ
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.
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).
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 %, respectively).
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 population and the rapid delivery of either reperjusion therapy'.
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
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1173-832419911199-000131$01.00° Adlalntemlltlonal Umlted 1999. All rights reaerved
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Inphanna-7 Aug 1999 No. 11119
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