Inpharma 1239 - 27 May 2000

Thrombolysis or primaryangioplasty in acute MI?

‘Thrombolytic therapy remains the reperfusionstrategy of choice’ in the majority of patients with acutemyocardial infarction (MI) who are admitted to hospitalswithout interventional facilities, say Drs Nick Robinsonand Adam Timmis from London Chest Hospital, London,UK.

They say that while randomised trial data suggest thatprimary angioplasty and stenting may have advantagesover thrombolytic therapy as a reperfusion strategy inthe emergency management of patients with acute MI,these trial data ‘need cautious interpretation’. DrsRobinson and Timmis explain that the data may bebiased by the limited number of patients and the highlyselected patient groups involved in trials. Recentlypublished observational data suggest that thrombolytictherapy may in fact compare favourably with primaryangioplasty, say Drs Robinson and Timmis.*

Nevertheless, they say that for patients with acute MIwho are admitted to hospitals with interventionalfacilities, ‘the trial data justify primary angioplasty andstenting for individual patients who can be moveddirectly from the emergency room to the catheterlaboratory’.

Thrombolytic therapy should be administered inhospitals lacking interventional facilities, ‘although thereshould be clearly defined protocols for the rapid transferto interventional centres of patients most likely to benefitfrom mechanical reperfusions’, (i.e. those withcontraindications to thrombolytic therapy, those whoexperience reinfarction following successfulthrombolysis and patients in whom thrombolysis hasfailed), say Drs Robinson and Timmis.* See Inpharma 1193: 15, 26 Jun 1999; 800767153

Robinson NM, et al. Reperfusion in acute myocardial infarction. BMJ 320:1354-1355, 20 May 2000 800820512

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Inpharma 27 May 2000 No. 12391173-8324/10/1239-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved