Authors' objectives:

The objective of the current report was to assess the scientific evidence comparing primary angioplasty (percutaneous coronary intervention or PCI, formerly percutaneous transluminal coronary angioplasty), and thrombolysis in acute myocardial infarction.

Authors' results and conclusions: Nineteen randomized clinical trials were identified. Two older trials were identified only from congress abstracts and were excluded. A metaanalysis of the data from the remaining seventeen trials) including 6,873 patients showed that there were fewer deaths, reinfactions and strokes in the acute phase among the patients who were treated with PCI. Six trials including 2,709 patients have reported the number of deaths up to at least one year from the acute infarction, it was still significantly lower among the patients treated with PCI. Time from the start of symptoms to initiation of treatment was important for the results of both thrombolysis and PCI, but more so for thrombolysis. Patients admitted to hospitals without facilities for PCI profited more by being transported to another hospital able to perform PCI then by receiving thrombolysis in the local hospital as long as the transfer did not delay treatment more than three hours. The group identified 21 articles containing original data about operator and hospital volume and the outcome after PCI. One was from Germany, the rest from the USA. Patients at high-volume hospitals had lower mortality and less often needed acute coronary surgery. Operators with low volumes more frequently had complications and their patients more frequently needed acute cardiac surgery. The randomized studies showing better results after PCI have usually been performed in high-volume hospitals. There is a danger that the difference between the treatment results may disappear or become reversed if the quality of the PCI is not good enough.

Authors' recommendations: Primary PCI is a better treatment than thrombolysis for patients with acute myocardial infarction admitted to an invasive centre. The combined outcomes of death, reinfarction or stroke in the acute phase is nearly halved, one such outcome is avoided for every 16 patients treated with PCI. Results more than one year after the infarction still significantly favour PCI. Patients with acute infarction can safely be transported to an invasive centre as long as the transport time is less than three hours. As both time to treatment start and hospital and operator volume are important for the outcome, the optimal treatment for acute myocardial infarction will differ in different settings. Clear treatment algorithms should be established for each geographical area.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.nokc.no/

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Norway

Organisation Name: Norwegian Institute of Public Health

Contact Address: Universitetsgata 2, Postbox 7004 St. Olavs plass, NO-0310 Oslo NORWAY. Tel: +47 23 25 50 00; Fax: +47 23 25 50 10;

Contact Name: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Contact Email: Berit.Morland@nokc.no, dagny.fredheim@nokc.no

Copyright: The Norwegian Knowledge Centre for the Health Services