Pharmacological treatment during AMI and in secondary prevention: the scientific evidence

Table 2. Primary angioplasty. Effect on mortality.
STUDY PROCEDURE No. PATIENTS FOLLOW-UP VAR. P
PAMI (1993) [37] PTCAvs tPA 395 In hosp. stay
PTCA 7.5
tPA 8.4 		-60.0% 0.06
Zwolle Trial (Zijlstra et al.) (1993) [103] PTCA vs SK 301 In hosp. stay
PTCA 12
SK 13.5		 -71.0% 0.003
MITI Project
Registry (1996) [25]		 PTCA vs THROMB. 1,272
2,664		 30 DAYS -1.7% 0.93
GUSTO IIb (1997) [37] PTCA vs tPA 1,138 30 DAYS -20.0% 0.37
Garcia et al. 1999 [27] PTCA vstPA 220 6 months -60 0.05
 
META-ANALYSES No. STUDIES No. PATIENTS FOLLOW-UP VAR. P
MICHELS (1995) [62]
(PTCA vs Thromb)		 7 1,145 6 WEEKS -44.0% <0.05

 

ACC/AHA GUIDELINES

  • Class I (1996):
    • as an alternative to thrombolytic therapy only if performed in a timely fashion by individuals skilled in the procedure and supported by experienced personnel in high-volume centres.
  • Class I (1999):
    • As an alternative to thrombolytic therapy in patients with AMI and ST-segment elevation or new or presumed new left BBB (LBBB) who can undergo angioplasty of the infarct-related artery within 12 hours of onset of symptoms or beyond 12 hours if ischemic symptoms persist, if performed in a timely fashion by persons skilled in the procedure† and supported by experienced personnel in an appropriate laboratory environment.
    • In patients who are within 36 hours of an acute ST-elevation/Q-wave or new LBBB MI who develop cardiogenic shock, are <75 years old, and in whom revascularization can be performed within 18 hours of onset of shock.
  • Class IIa (1996):
    • As a reperfusion strategy in patients who are candidates for reperfusion but who have a risk of bleeding contraindication to thrombolytic therapy
    • Patients in cardiogenic shock
  • Class IIa (1999):
    • As a reperfusion strategy in candidates for reperfusion who have a contraindication to thrombolytic therapy.
  • Class IIb (1996):
    • As a reperfusion strategy in patients who fail to qualify for thrombolytic therapy for reasons other than risk of bleeding contraindications.
  • Class IIb (1999):
    • In patients with AMI who do not present with ST elevation but who have reduced (less than TIMI grade 2) flow of the infarct-related artery and when angioplasty can be performed within 12 hours of onset of symptoms.

ANMCO-SIC CLINICAL GUIDELINES

In centres with considerable experience in PTCA and with the possibility of a staff able to do it quickly (in less than 1 hour) and who is available 24hrs a day, PTCA as a first choice has considerable advantages, especially in patients with contraindications for thrombolysis, or with extensive infarct or AMI with LV failure.


Related articles:  [110], [111]