Author + information
- Received February 18, 1998
- Revision received July 1, 1998
- Accepted July 24, 1998
- Published online November 15, 1998.
- Flavio Ribichini, MDa,
- Giuseppe Steffenino, MDa,* (, )
- Antonio Dellavalle, MDa,
- Valeria Ferrero, MDa,
- Antonello Vado, MDa,
- Mauro Feola, MDa and
- Eugenio Uslenghi, MDa
- ↵*Address for correspondence: Dr. Giuseppe Steffenino, Laboratorio di Emodinamica, Ospedale Santa Croce, Via Michele Coppino 26, 12100 Cuneo, Italia
Objectives. The aim of the study was to compare randomly assigned primary angioplasty and accelerated recombinant tissue plasminogen activator (rt-PA), in patients with “high-risk” inferior acute myocardial infarction (ST-segment elevation in the inferior leads and ST-segment depression in the precordial leads).
Background. The ST-segment depression in the precordial leads is a marker of severe prognosis in patients with inferior myocardial infarction. The comparative outcome of treatment with primary angioplasty or lysis with accelerated rt-PA has not been investigated.
Methods. One hundred and ten patients within 6 h of symptoms were randomized to either treatment. To assess the in-hospital and 1-year outcome of both treatments the following results were compared: death or nonfatal infarction, recurrence of angina, left ventricular ejection fraction (LVEF), and the need for repeat target vessel revascularization (TVR).
Results. In patients treated with angioplasty (55) and rt-PA (55) the rate of in-hospital mortality and reinfarction was 3.6% versus 9.1% (p= 0.4). Recurrence of angina was 1.8% versus 20% (p = 0.002), new TVR was used in 3.6% versus 29.1% (p = 0.0003), and the LVEF (%) at discharge was 55.2 ± 9.5 versus 48.2 ± 9.9 (p = 0.0001). There were no hemorrhagic strokes, no emergency coronary artery bypass graft (CABG) and identical (5.5%) need for blood transfusions. At 1 year, the incidence of death, reinfarction or repeat TVR was 11% in the percutaneous transluminal coronary angioplasty (PTCA) group versus 52.7% in the rt-PA group (log-rank 22.38, p < 0.0001).
Conclusions. Primary angioplasty is superior to accelerated rt-PA in terms of both myocardial preservation and reduction of in-hospital complications in patients with inferior myocardial infarction and precordial ST-segment depression. Primary angioplasty also yields a better long-term event-free survival.
☆ No financial support for this study is to be acknowledged.
- Received February 18, 1998.
- Revision received July 1, 1998.
- Accepted July 24, 1998.
- American College of Cardiology