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document
Influence of acute myocardial infarction location on in-hospital and late outcome after primary percutaneous transluminal coronary angioplasty versus tissue plasminogen activator therapy . In the Primary Angioplasty in Myocardial Infarction trial , 395 patients with acute myocardial infarction ( AMI ) were prospectively randomized to tissue plasminogen activator ( tPA ) or primary percutaneous transluminal coronary angioplasty ( PTCA ) . In 138 patients with anterior wall AMI , in-hospital mortality was significantly reduced by treatment with PTCA compared with tPA ( 1.4 % vs 11.9 % , p = 0.01 ) . PTCA also resulted in lower rates of death or reinfarction ( 1.4 % vs 18.0 % , p = 0.0009 ) , recurrent myocardial ischemia ( 11.3 % vs 28.4 % , p = 0.01 ) , and stroke ( 0.0 % vs 6.0 % , p = 0.037 ) in anterior wall AMI . The independent beneficial effect of treatment with primary PTCA rather than tPA in anterior wall AMI was confirmed by multivariate analysis and interaction testing . The in-hospital mortality of 257 patients with nonanterior wall AMI was similar after PTCA and tPA ( 3.2 % vs 3.8 % , p = 0.82 ) . Compared with tPA , however , primary PTCA resulted in a markedly lower rate of recurrent myocardial ischemia ( 9.7 % vs 27.8 % , p = 0.0002 ) , fewer unscheduled catheterization and revascularization procedures , and a shorter hospital stay ( 7.0 vs 8.6 days , p = 0.01 ) in nonanterior wall AMI . Thus , compared with tPA , primary PTCA in patients with anterior wall AMI results in significantly improved survival , with lower rates of stroke , reinfarction , and recurrent myocardial ischemia . In nonanterior wall AMI , treatment with PTCA and tPA results in similar early mortality , although PTCA-treated patients have a more stable hospital course characterized by reduced recurrent ischemia , fewer subsequent invasive procedures , and earlier discharge .
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Intervention_Surgical
primary percutaneous transluminal coronary angioplasty
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Intervention_Surgical
tissue plasminogen activator therapy
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Intervention_Physical
tissue plasminogen activator ( tPA
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Intervention_Surgical
)
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Intervention_Physical
primary percutaneous transluminal coronary angioplasty ( PTCA )
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Outcome_Mortality
in-hospital mortality
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Outcome_Other
rates
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Outcome_Mortality
death or reinfarction
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Outcome_Physical
recurrent myocardial ischemia
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Outcome_Physical
stroke
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Outcome_Mortality
in-hospital mortality
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Outcome_Physical
recurrent myocardial ischemia
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Outcome_Adverse-effects
unscheduled catheterization
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Outcome_Physical
revascularization procedures
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Outcome_Other
hospital stay
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Outcome_Mortality
improved survival
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Outcome_Adverse-effects
rates of
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Outcome_Physical
stroke
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Outcome_Physical
reinfarction
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Outcome_Physical
recurrent myocardial ischemia
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Outcome_Mortality
mortality
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Outcome_Physical
recurrent ischemia
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Outcome_Other
subsequent invasive procedures
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Outcome_Other
discharge
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Participant_Condition
acute myocardial infarction
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Participant_Sample-size
395
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Participant_Condition
AMI
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Participant_Sample-size
138
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Participant_Sample-size
257