Primary angioplasty with routine stenting compared with thrombolytic therapy in elderly patients with acute myocardial infarction.

Am Heart J 2003 May;145(5):862-7

Heart Institute, Sheba Medical Center, Tel Hashomer, Israel.

Background: Prior studies have yielded conflicting data on the advantage of primary angioplasty compared with thrombolysis in elderly patients with acute myocardial infarction (AMI). These studies, however, were performed before the contemporary widespread use of intracoronary stents and glycoprotien IIb/IIIa antagonists.

Methods: We prospectively compared the outcome of 130 consecutive elderly patients (aged > or =70 years) with ST-elevation AMI who were admitted to 2 similar neighboring medical centers. Patients were assigned to receive either thrombolytic therapy with accelerated tissue-type plasminogen activator (center I) or primary angioplasty with routine stenting (center II).

Results: Of the patients assigned to receive primary angioplasty, 91% underwent stenting. At 6 months, patients treated with primary angioplasty, compared with those treated with thrombolytic therapy, had a lower incidence of reinfarction (2% vs 14%, P =.053) and revascularization for recurrent ischemia (9% vs 61%, P <.001) and a significant reduction in the prespecified combined end point of death, reinfarction, or revascularization for recurrent ischemia (29% vs 93%, P <.01). Primary angioplasty remained an independent predictor of the triple combined end point after controlling for potential covariables (relative risk 0.63, 95% CI 0.38-0.84). Major bleeding complications were also significantly reduced in the primary angioplasty group (0% vs 17%, P =.03).

Conclusions: Compared with thrombolysis, primary angioplasty with routine stenting in elderly patients with AMI is associated with better clinical outcomes and a lower risk of bleeding complications.

Download full-text PDF

Source
http://linkinghub.elsevier.com/retrieve/pii/S000287030294709
Publisher Site
http://dx.doi.org/10.1016/S0002-8703(02)94709-5DOI Listing
May 2003
23 Reads

Publication Analysis

Top Keywords

primary angioplasty
20
elderly patients
12
thrombolytic therapy
12
patients assigned
8
patients acute
8
acute myocardial
8
myocardial infarction
8
assigned receive
8
angioplasty compared
8
angioplasty routine
8
routine stenting
8
patients
6
primary
5
neighboring medical
4
admitted neighboring
4
tissue-type plasminogen
4
medical centers
4
centers patients
4
receive thrombolytic
4
accelerated tissue-type
4

Similar Publications