Primary angioplasty or thrombolysis for acute myocardial infarction?

Sir Should we believe the unequivocal finding of Ellen Keeley and co-workers1 that “primary PTCA is more effective than thrombolytic therapy for the treatment of ST-segment elevation AMI”? In the SHOCK trial, only 63% of medically treated patients received thrombolysis and only 23% were randomised t...

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Bibliographic Details
Published in:The Lancet (British edition) 2003-03, Vol.361 (9361), p.966-966
Main Author: Melandri, Giovanni
Format: Article
Language:English
Subjects:
Angioplasty
Angioplasty, Balloon, Coronary
Catheters
Fibrinolytic Agents - therapeutic use
Humans
Hypotheses
Mortality
Myocardial infarction
Myocardial Infarction - drug therapy
Myocardial Infarction - therapy
Stroke
Thrombolysis
Tissue Plasminogen Activator - therapeutic use
Treatment Outcome
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Summary:Sir Should we believe the unequivocal finding of Ellen Keeley and co-workers1 that “primary PTCA is more effective than thrombolytic therapy for the treatment of ST-segment elevation AMI”? In the SHOCK trial, only 63% of medically treated patients received thrombolysis and only 23% were randomised to treatment within 6 h of onset of symptoms. [...]there was no opportunity for thrombolysis to be effective. The work by Keeley and colleagues is extremely interesting, but needs confirmation in a large trial to compare primary PTCA with the quick infusion of a modern thrombolytic agent; such a trial must to be of sufficient power to show a reduction in mortality as its primary end point. [...]proven otherwise, thrombolysis should not be regarded as an inferior therapy.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(03)12747-X