Contemporary Mortality Differences Between Primary Percutaneous Coronary Intervention and Thrombolysis in ST-Segment Elevation Myocardial Infarction

Abstract

Modern thrombolytic strategies have substantially attenuated the absolute mortality benefit of PPCI over thrombolysis, particularly in patients not at high risk. Our study findings suggest that target door-to-balloon time should be less than 60 minutes to maintain the lowest mortality rates.

Long-term implications of further ST elevation during thrombolytic therapy on left ventricular function

“…For a variety of logistic and economic reasons, intravenous thrombolysis is still a widely used mode of reperfusion therapy and the ST segment changes continue to be the paradigm of the clinical diagnosis of myocardial reperfusion [3][4][5][6][7]. Despite the large number of publications dealing with the ST segment criteria for reperfusion, however, only a few and with a small number of patients have analyzed the phenomenon of STRE during thrombolysis [13,14,17,18].…”

“…Despite the increasing implementation of primary percutaneous coronary intervention (PCI) as the reperfusion therapy of choice for ST segment elevation myocardial infarction (STEMI) [1,2], there is still wide use of thrombolytic therapy largely because of economic and logistic restraints [3][4][5][6][7]. At the same time, there is ample recognition of the close correlation between at least 50% recovery of ST segment elevation during the first 60-90 min following lytic therapy and evidence of myocardial reperfusion [8][9][10][11].…”

Universal Access to a Percutaneous Coronary Intervention Hospital

“…17 To overcome this, some centers have been successful in improving interhospital transfer times through targeted interventions (strengthening of emergency medical response and systematic treatment protocols) 18 ; this requires substantial investment that may not be realistic for all hospitals and communities. With new evidence suggesting that modern thrombolytic therapy has substantially attenuated the mortality benefit from primary PCI, 19 it may be time to re-examine initial thrombolysis as a reperfusion strategy for eligible patients, followed by transfer to a PCI hospital. As we deliberate strategies to deliver optimal care to patients with STEMI, especially those who present to non-PCI hospitals, we may be well served to also learn from technological innovations in the area of stroke regionalization.…”

Why Does Primary Angioplasty Not Work in Registries? Quantifying the Susceptibility of Real-World Comparative Effectiveness Data to Allocation Bias

“…We varied how the higher-risk patients were allocated between arms to test how easily the odds ratio can be influenced by biased allocation of this patient subgroup. Model parameters were based on published data , 1,[15][16][17][18]23,24 (Table 1). …”

“…First, we constructed a model using values from prior studies 1,[15][16][17][18][19] to quantify, simplistically, how easily unequal allocation of higher-risk patients to an intrinsically better therapeutic arm can appear to abolish its benefit.…”