15562
document
Early reperfusion and late clinical outcomes in patients presenting with acute myocardial infarction randomly assigned to primary percutaneous coronary intervention or streptokinase . BACKGROUND Primary percutaneous coronary intervention ( PCI ) has become an alternative to thrombolytic therapy as a reperfusion strategy for ST-elevation acute myocardial infarction ( AMI ) . METHODS The main goal of this study was to determine whether PCI and thrombolytic therapy achieve comparable reperfusion rates , as evidenced by ST-segment resolution . Secondary end points included infarct vessel patency rates before hospital discharge and short- and long-term outcomes . Patients with ischemic chest pain with duration < or =12 hours and no contraindication for thrombolytic therapy were included . RESULTS Between October 1993 and August 1995 , 58 patients were randomly assigned to streptokinase ( SK ) and 54 patients to primary PCI . Baseline clinical characteristics and infarct location were well balanced in both groups . Median age ( interquartile range ) was 68 ( 58 , 75 ) years , 29 % were women , and 78 % of the patients met at least one criterion for " not low risk " AMI ( anterior location , age > 70 years old , previous MI , systolic blood pressure < 100 mm Hg , and/or heart rate > 100 bpm ) . The median time from symptom onset to random assignment was 217 ( 139 , 335 ) minutes in the PCI group and 210 ( 145 , 334 ) minutes in the SK group . Median random assignment to balloon time was 82 ( 55 , 100 ) minutes , and median random assignment to needle time was 15 ( 10 , 26 ) minutes ( P < .0001 ) . TIMI grade 3 flow after primary PCI was obtained in 85 % of patients . The proportion of patients with ST-segment resolution > or =50 % at 120 minutes was 80 % in the PCI group and 50 % in the SK group ( P =.001 ) . The predischarge angiogram showed the presence of TIMI 3 flow in 96 % of patients who received PCI and 65 % of patients who received SK ( P < .001 ) . A composite of in-hospital death , reinfarction , severe heart failure , stroke , and major bleeding occurred in 15 % of patients who received PCI and 21 % of patients who received SK ( P =.4 ) . At 3 years , freedom from the composite end point of AMI , postdischarge revascularization , and death was 61 % in the PCI group and 40 % in the SK group ( P =.025 ) . CONCLUSIONS Our study shows that primary PCI , as compared with SK , is associated with more effective ST-segment resolution , higher patency rates in the infarct vessel at 7 days , and more favorable clinical outcomes at 3 years of follow-up .
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Intervention_Physical
primary percutaneous coronary intervention
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Intervention_Pharmacological
streptokinase
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Intervention_Physical
Primary percutaneous coronary intervention ( PCI )
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Intervention_Pharmacological
thrombolytic therapy
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Intervention_Physical
PCI
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Intervention_Pharmacological
thrombolytic therapy
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Intervention_Pharmacological
streptokinase ( SK )
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Intervention_Physical
primary PCI
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Intervention_Physical
PCI
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Intervention_Pharmacological
SK
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Outcome_Physical
infarct vessel patency rates
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Outcome_Physical
blood pressure
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Outcome_Physical
median time from symptom onset
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Outcome_Physical
balloon time
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Outcome_Other
needle time
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Outcome_Physical
TIMI grade 3 flow
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Outcome_Physical
ST-segment resolution
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Outcome_Physical
presence of TIMI 3 flow
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Outcome_Mortality
in-hospital death
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Outcome_Physical
reinfarction
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Outcome_Physical
severe heart failure
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Outcome_Physical
stroke
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Outcome_Physical
major bleeding
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Outcome_Mortality
composite end point of AMI
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Outcome_Physical
postdischarge revascularization
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Outcome_Physical
ST-segment resolution
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Outcome_Physical
patency rates
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Participant_Condition
patients presenting with acute myocardial infarction
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Participant_Condition
ST-elevation acute myocardial infarction ( AMI ) .
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Participant_Condition
ischemic chest pain
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Participant_Sample-size
58
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Participant_Sample-size
54
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Participant_Age
68
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Participant_Sex
women
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Participant_Age
> 70 years