[Favorable long-term results of primary percutaneous transluminal coronary angioplasty in acute myocardial infarction compared to intravenous streptokinase treatment; a randomized study].

OBJECTIVE

To evaluate the treatment of patients with acute myocardial infarction with thrombolytic drugs or primary angioplasty in a randomized trial.

DESIGN

Randomized trial.

SETTING

Hospital De Weezenlanden, Zwolle, the Netherlands.

METHODS

A total of 301 patients with acute myocardial infarction were included in the trial, of whom 152 patients were allocated to primary angioplasty and 149 patients to intravenous streptokinase. The mean follow-up duration was 31 months (SD:9). Left ventricular function was assessed with a radionuclide technique before hospital discharge and at the end of the follow-up period. A cost analysis was performed based on the calculation of all medical costs.

RESULTS

At the end of the follow-up period, 5% of the angioplasty patients had died from a cardiac cause compared with 11% of the patients randomized to intravenous streptokinase (p = 0.031). Death or non-fatal reinfarction occurred in 7% of angioplasty patients and in 28% of streptokinase patients (p < 0.001). There was a sustained beneficial effect of angioplasty in comparison with streptokinase on left ventricular function, 48 (SD12)% versus 43(SD13)% (p < 0.01). Most benefit was observed in patients with an anterior wall myocardial infarction.

CONCLUSION

After an average of 31 months (SD:9) primary angioplasty in comparison with intravenous streptokinase resulted in a lower rate of cardiac death and reinfarction and a better left ventricular ejection fraction, without an increase in total costs.