Outcome of different reperfusion strategies in patients with former contraindications to thrombolytic therapy: a comparison of primary angioplasty and tissue plasminogen activator. Primary Angioplasty in Myocardial Infarction (PAMI) Investigators

Catheterization and Cardiovascular Diagnosis
G W StoneW O'Neill

Abstract

High-risk patients have been excluded from most thrombolytic trials because of concern over hemorrhagic complications or lack of efficacy. However, based on several recent studies suggesting that patients with relative thrombolytic contraindications may also benefit from reperfusion, recommendations have been made to broadly expand the eligibility criteria for thrombolytic therapy, despite higher absolute complication rates. Primary percutaneous transluminal coronary angioplasty (PTCA) may be an attractive alternative for patients presenting at appropriately equipped hospitals who would otherwise remain at high risk after thrombolytic therapy. In the Primary Angioplasty in Myocardial Infarction (PAMI) trial, 395 patients with acute myocardial infarction were randomized to tissue plasminogen activator (t-PA) or primary PTCA. Conditions were present in 151 patients (38%) which formerly would have contraindicated thrombolytic therapy (age > 70 yr, symptom duration > 4 hr, or prior bypass surgery). In-hospital mortality was 4.3-fold higher in patients with former thrombolytic contraindications compared to lytic-eligible patients (8.6% vs. 2.0%, P = .002). Lytic-eligible patients treated with t-PA and PTCA had similar in-hospital mo...Continue Reading

References

Aug 1, 1991·Annals of Internal Medicine·D R CraggT L Schreiber
Jul 1, 1990·Journal of the American College of Cardiology·C L Grines, A N DeMaria
Dec 1, 1988·Journal of the American College of Cardiology·E J TopolK L Lee
Apr 4, 1985·The New England Journal of Medicine·UNKNOWN TIMI Study Group
Apr 1, 1994·The American Journal of Cardiology·W W O'NeillL G Berdan
Jun 16, 1994·The New England Journal of Medicine·R M Califf, J R Bengtson

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Citations

Dec 1, 1996·Catheterization and Cardiovascular Diagnosis·J K Kahn
Nov 26, 2008·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Timm BauerUwe Zeymer

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