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(Circulation. 2000;101:e211.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Treatment of Acute Myocardial Infarction by Primary Coronary Angioplasty or Intravenous Thrombolysis

Peter B. Berger, MD

Associate Professor of Medicine Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905

	Introduction

 
To the Editor:

The importance of time to reperfusion among patients with acute myocardial infarction treated with thrombolytic therapy has been firmly established. Recent data suggest that time to reperfusion is a critical determinant of outcome with direct angioplasty as well.¹ The primary reason balloon angioplasty has been associated with a better outcome than thrombolytic therapy in nearly all comparative randomized trials is likely that it can achieve reperfusion more rapidly in a greater number of patients.^{2 3} It was with considerable surprise, therefore, that I read the registry report by Danchin et al⁴ in which they reported that, contrary to the results of randomized trials, the outcomes of patients receiving thrombolysis and primary angioplasty in the "real world" were similar.

Danchin et al’s⁴ study has 2 important shortcomings. First, the authors did not, in fact, perform "primary coronary angioplasty" because they included patients admitted up to 6 hours after the onset of symptoms and then performed angioplasty up to 24 hours after hospital admission. Direct coronary angioplasty refers specifically to angioplasty performed early during an infarction in patients with persistent pain and ECG changes and not to angioplasty performed in the 24 hours after infarction. The investigators acknowledged performing percutaneous transluminal coronary angioplasty (PTCA) later than 6 hours after the onset of symptoms in "many patients, at a time when a little benefit might be expected from the procedure" in terms of a reduction in early mortality. One can only wonder how much better the PTCA patients would have done . . . [Full Text of this Article]

Nicolas Danchin, MD; Laurent Vaur, MD; Nathalie Genès, MD; Sylvie Etienne, MD; Michaël Angioï, MD; Jean Ferrières, MD; Jean-Pierre Cambou, MD

Service de Cardiologie, Chu Nancy-Brabois, 54500 Vandoeuvre-les-Nancy, France