We sought to compare primary coronary angioplasty and thrombolysis as treatment for low risk patients with an acute myocardial infarction.
Primary coronary angioplasty is the most effective reperfusion therapy for patients with acute myocardial infarction ; however, intravenous thrombolysis is easier to apply, more widely available and possibly more appropriate in low risk patients.
We stratified 240 patients with acute myocardial infarction at admission according to risk.
Low risk patients (n=95) were randomized to primary angioplasty or thrombolytic therapy.
The primary end point was death, nonfatal stroke or reinfarction during 6 months of follow-up.
Left ventricular ejection fraction and medical charges were secondary end points.
High risk patients (n=145) were treated with primary angioplasty.
In low risk patients, the incidence of the primary clinical end point (4% vs. 20%, p<0.02) was lower in the group with primary coronary angioplasty than in the group with thrombolysis, because of a higher rate of reinfarction in the latter group.
Mortality and stroke rates were low in both treatment groups.
There were no differences in left ventricular ejection fraction or total medical charges.
High risk patients had a 14% incidence rate of the primary clinical end point.
Simple clinical data can be used to risk-stratify patients during the initial admission for myocardial infarction. (...)
Mots-clés Pascal : Infarctus, Myocarde, Aigu, Dilatation instrumentale, Artère coronaire, Streptokinase, Risque, Faible, Analyse coût, Economie santé, Chimiothérapie, Traitement, Technique, Efficacité traitement, Homme, Etude comparative, Fibrinolytique, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie, Traitement instrumental
Mots-clés Pascal anglais : Infarct, Myocardium, Acute, Instrumental dilatation, Coronary artery, Streptokinase, Risk, Low, Cost analysis, Health economy, Chemotherapy, Treatment, Technique, Treatment efficiency, Human, Comparative study, Fibrinolytic, Cardiovascular disease, Coronary heart disease, Myocardial disease, Instrumentation therapy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0251625
Code Inist : 002B12A03. Création : 11/06/1997.