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PTCA/PCI vs thrombolysis for acute MI

Management: - PCI (PTCA) more effective than thrombolytic therapy [1,2] - PCI (PTCA) within 90 minutes of first medical contact - if door to balloon time (PCI) exceeds door to needle time (thrombolysis) by > 60 minutes, consider thrombolysis [5] - thrombolysis -> angiography -> coronary stenting [3] - transfer to PCI-capable hospital should routinely follow thrombolysis [4] Clinical trials: Meta-analysis of 23 trials, involving 7739 patients with ST segment elevation. Combined endpoint of death, re-infarction, stroke: - 8% with PTCA - 14% with thrombolytic therapy

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myocardial infarction (MI); heart attack percutaneous transluminal coronary angioplasty (PTCA) thrombolysis for acute myocardial infarction

References

  1. Journal Watch 23(5):42, 2003 - Keeley EC et al Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361:12, 2003 PMID: 12517460
  2. van 't Hof AW, Rasoul S, van de Wetering H, Ernst N, Suryapranata H, Hoorntje JC, Dambrink JH, Gosselink M, Zijlstra F, Ottervanger JP, de Boer MJ; On-TIME study group. Feasibility and benefit of prehospital diagnosis, triage, and therapy by paramedics only in patients who are candidates for primary angioplasty for acute myocardial infarction. Am Heart J. 2006 Jun;151(6):1255.e1-5. PMID: 16781231 http://dx.doi.org/10.1016/j.ahj.2006.03.014
  3. Journal Watch 24(22):166, 2004 Fernandez-Aviles F, Alonso JJ, Castro-Beiras A, Vazquez N, Blanco J, Alonso-Briales J, Lopez-Mesa J, Fernandez-Vazquez F, Calvo I, Martinez-Elbal L, San Roman JA, Ramos B; GRACIA (Grupo de Analisis de la Cardiopatia Isquemica Aguda) Group. Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA-1): a randomised controlled trial. Lancet. 2004 Sep 18;364(9439):1045-53. PMID: 15380963
  4. Cantor WJ et al Routine Early Angioplasty after Fibrinolysis for Acute Myocardial Infarction N Engl J Med 2009, 360:2705-2718 PMID: 19553646 http://content.nejm.org/cgi/content/short/360/26/2705
  5. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society