Thrombolysis still the 'gold standard'in acute MI

VIEWS & REVIEWS

'Thrombolytic therapy is still the gold standard for early treatment of acute transmural myocardial infarction [MIl' says Dr FWA Verheugt from the University Hospital Nijmegen, The Netherlands.

Dr Verheugt notes that this is in spite of the option of using primary angioplasty in acute MI. A number of small studies have demonstrated primary angioplasty in acute MI to be associated with a much lower mortality rate than thrombolysis. However, the results of a substudy from the GUSTO-II· trial are less conclusive. In this study, mortality rates were similar with both interventions and the reperfusion rate was only slightly greater in patients undergoing primary angioplasty compared with those receiving thrombolysis.

Angioplasty expensive Dr Verheugt also notes that cost is a drawback of

primary angioplasty. The procedure is only available at tertiary centres and if primary angioplasty were to become the treatment of choice for acute MI it would be expensive to increase the number of angioplasty facilities.

While angioplasty is an effective and 'probably safe' alternative to thrombolysis in acute MI it is not yet possible to state that one intervention is superior to the other, concludes Dr Verheugt. • Global Use ojStraU!gies tc Open Occluded Arteries in Acute Coronary Syndrome-O; see Jrrphanna 1033: 13, 20 Apr 1996; lHJ431029 Verlleugt FWA. Primary angioplasty for acute myocan1ial infarction: is the balloon balffull ofbalfempty?Lancet 347: 1276-1277, 11 May 1996 .........

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Inphanna-1' ray 18118 No. 1037