We randomly assigned 56 patients who presented within 12 hours of their first symptoms of acute myocardial infarction to treatment with either intracoronary streptokinase or coronary angioplasty. The mean (+/- SD) duration of symptoms (3.0 +/- 1.2 hours in the group treated with angioplasty vs. 3.6 +/- 1.8 in the group treated with streptokinase; P not significant) and time to recanalization (4.1 +/- 1.4 hours vs. 4.8 +/- 1.7 hours; P not significant) were similar in both groups. Coronary recanalization was achieved in 83 percent of the patients treated with angioplasty and in 85 percent of those treated with streptokinase (P not significant). Residual luminal stenosis in the coronary artery was significantly decreased after angioplasty, as compared with streptokinase therapy (43 +/- 31 percent of patients vs. 83 +/- 17; P less than 0.001). Residual stenosis of 70 percent or more was present in 4 percent of the angioplasty-treated patients and in 83 percent of the streptokinase-treated patients (P less than 0.01). Ventricular function after therapy was assessed by serial contrast ventriculograms. Increases in both global ejection fraction (8 +/- 7 percent vs. 1 +/- 6; P less than 0.001) and regional wall motion (+1.32 +/- 1.32 SD vs. +0.59 +/- 0.79 SD; P less than 0.05) were greater for the angioplasty group. We conclude that angioplasty and streptokinase produce similar rates of early coronary reperfusion during evolving transmural myocardial infarction. However, angioplasty is significantly more effective in alleviating the underlying coronary stenoses, and this may result in more effective preservation of ventricular function after therapy.
This article has been cited by other articles:
Hollenbeak, C. S., Fitzgibbons, J. P., Rossi, M., Morris, D. L., Stillman, P.
(2007). The Impact of Percutaneous Coronary Interventions on Outcomes for Acute Myocardial Infarction in Pennsylvania. American Journal of Medical Quality
22: 85-94
[Abstract]
Moscucci, M., Eagle, K. A.
(2006). Reducing the Door-to-Balloon Time for Myocardial Infarction with ST-Segment Elevation. NEJM
355: 2364-2365
[Full Text]
Wharton, T. P. Jr, Keeley, E. C., Grines, C. L., Wharton, T. P. Jr, Keeley, E. C., Grines, C. L.
(2005). The Case for Community Hospital Angioplasty. Circulation
112: 3509-3534
[Full Text]
Magid, D. J., Wang, Y., Herrin, J., McNamara, R. L., Bradley, E. H., Curtis, J. P., Pollack, C. V. Jr, French, W. J., Blaney, M. E., Krumholz, H. M.
(2005). Relationship Between Time of Day, Day of Week, Timeliness of Reperfusion, and In-Hospital Mortality for Patients With Acute ST-Segment Elevation Myocardial Infarction. JAMA
294: 803-812
[Abstract][Full Text]
de Kam, P. J, Voors, A. A, Fici, F., van Veldhuisen, D. J, van Gilst, W. H
(2004). Review: The revised role of ACE-inhibition after myocardial infarction in the thrombolytic/primary PCI era. Journal of Renin-Angiotensin-Aldosterone System
5: 161-168
[Abstract]
Dauerman, H. L., Sobel, B. E.
(2003). Synergistic treatment of ST-segmentelevation myocardial infarction with pharmacoinvasive recanalization. J Am Coll Cardiol
42: 646-651
[Abstract][Full Text]
Natarajan, M. K., Yusuf, S.
(2003). Primary angioplasty for ST-segment elevation myocardial infarction: Ready for prime time?. CMAJ
169: 32-35
[Full Text]
Nijland, F, Kamp, O, Verhorst, P M J, de Voogt, W G, Visser, C A
(2002). Early prediction of improvement in ejection fraction after acute myocardial infarction using low dose dobutamine echocardiography. Heart
88: 592-596
[Abstract][Full Text]
Goldstein, J. A.
(2002). Pathophysiology and management of right heart ischemia. J Am Coll Cardiol
40: 841-853
[Abstract][Full Text]
Zahn, R., Schiele, R., Schneider, S., Gitt, A. K., Wienbergen, H., Seidl, K., Voigtlander, T., Gottwik, M., Berg, G., Altmann, E., Rosahl, W., Senges, J., for the Maximal Individual Therapy in Acute Myocar,
(2001). Primary angioplasty versus intravenous thrombolysis in acute myocardial infarction: can we define subgroups of patients benefiting most from primary angioplasty?: Results from the pooled data of the maximal individual therapy in acute myocardial infarction registry and the myocardial infarction registry. J Am Coll Cardiol
37: 1827-1835
[Abstract][Full Text]
Magid, D. J., Calonge, B. N., Rumsfeld, J. S., Canto, J. G., Frederick, P. D., Every, N. R., Barron, H. V., for the National Registry of Myocardial Infarction,
(2000). Relation Between Hospital Primary Angioplasty Volume and Mortality for Patients With Acute MI Treated With Primary Angioplasty vs Thrombolytic Therapy. JAMA
284: 3131-3138
[Abstract][Full Text]
Zahn, R., Schiele, R., Schneider, S., Gitt, A. K., Wienbergen, H., Seidl, K., Bossaller, C., Buttner, H. J., Gottwik, M., Altmann, E., Rosahl, W., Senges, J., for the Maximal Individual Therapy in Acute Myocar,
(2000). Decreasing hospital mortality between 1994 and 1998 in patients with acute myocardial infarction treated with primary angioplasty but not in patients treated with intravenous thrombolysis: Results from the pooled data of the maximal individual therapy in acute myocardial infarction (MITRA) registry and the myocardial infarction registry (MIR). J Am Coll Cardiol
36: 2064-2071
[Abstract][Full Text]
Hannan, E. L., Racz, M. J., Arani, D. T., Ryan, T. J., Walford, G., McCallister, B. D.
(2000). Short- and long-term mortality for patients undergoing primary angioplasty for acute myocardial infarction. J Am Coll Cardiol
36: 1194-1201
[Abstract][Full Text]
Wharton, T. P. Jr., McNamara, N. S., Fedele, F. A., Jacobs, M. I., Gladstone, A. R., Funk, E. J.
(1999). Primary angioplasty for the treatment of acute myocardial infarction: experience at two community hospitals without cardiac surgery. J Am Coll Cardiol
33: 1257-1265
[Abstract][Full Text]
Nunn, C. M., O'Neill, W. W., Rothbaum, D., Stone, G. W., O'Keefe, J., Overlie, P., Donohue, B., Grines, L., Browne, K. F., Vlietstra, R. E., Catlin, T., Grines, C. L., For The Primary Angioplasty in Myocardial Infarcti,
(1999). Long-term outcome after primary angioplasty: report from the Primary Angioplasty in Myocardial Infarction (PAMI-I) trial. J Am Coll Cardiol
33: 640-646
[Abstract][Full Text]
Horie, H., Takahashi, M., Minai, K., Izumi, M., Takaoka, A., Nozawa, M., Yokohama, H., Fujita, T., Sakamoto, T., Kito, O., Okamura, H., Kinoshita, M.
(1998). Long-Term Beneficial Effect of Late Reperfusion for Acute Anterior Myocardial Infarction With Percutaneous Transluminal Coronary Angioplasty. Circulation
98: 2377-2382
[Abstract][Full Text]
Bowers, T. R., O'Neill, W. W., Grines, C., Pica, M. C., Safian, R. D., Goldstein, J. A.
(1998). Effect of Reperfusion on Biventricular Function and Survival after Right Ventricular Infarction. NEJM
338: 933-940
[Abstract][Full Text]
White, R. L
(1998). Thrombolytic Therapy in Acute Myocardial Infarction Part II: 1997 Update. Asian Cardiovasc. Thorac. Ann.
6: 03-10
[Abstract][Full Text]
Weaver, W. D., Simes, R. J., Betriu, A., Grines, C. L., Zijlstra, F., Garcia, E., Grinfeld, L., Gibbons, R. J., Ribeiro, E. E., DeWood, M. A., Ribichini, F.
(1997). Comparison of Primary Coronary Angioplasty and Intravenous Thrombolytic Therapy for Acute Myocardial Infarction: A Quantitative Review. JAMA
278: 2093-2098
[Abstract]
Yusuf, S., Pogue, J.
(1997). Primary Angioplasty Compared With Thrombolytic Therapy for Acute Myocardial Infarction. JAMA
278: 2110-2111
[Abstract]
Carrozza, J. P. Jr, Baim, D. S.
(1997). Keeping the Open Artery Open : Is Stenting the Answer?. Circulation
96: 2762-2764
[Full Text]
Every, N. R., Parsons, L. S., Hlatky, M., Martin, J. S., Weaver, W. D., The Myocardial Infarction Triage and Intervention,
(1996). A Comparison of Thrombolytic Therapy with Primary Coronary Angioplasty for Acute Myocardial Infarction. NEJM
335: 1253-1260
[Abstract][Full Text]
Ohnishi, Y., Butterfield, M. C., Saffitz, J. E., Sobel, B. E., Corr, P. B., Goldstein, J. A.
(1995). Deleterious Effects of a Systemic Lytic State on Reperfused Myocardium : Minimization of Reperfusion Injury and Enhanced Recovery of Myocardial Function by Direct Angioplasty. Circulation
92: 500-510
[Abstract][Full Text]
Michels, K. B., Yusuf, S.
(1995). Does PTCA in Acute Myocardial Infarction Affect Mortality and Reinfarction Rates? : A Quantitative Overview (Meta-Analysis) of the Randomized Clinical Trials. Circulation
91: 476-485
[Abstract][Full Text]
Grines, C. L., Browne, K. F., Marco, J., Rothbaum, D., Stone, G. W., O'Keefe, J., Overlie, P., Donohue, B., Chelliah, N., Timmis, G. C., Vlietstra, R. E., Strzelecki, M., Puchrowicz-Ochocki, S., O'Neill, W. W., The Primary Angioplasty in Myocardial Infarction S,
(1993). A Comparison of Immediate Angioplasty with Thrombolytic Therapy for Acute Myocardial Infarction. NEJM
328: 673-679
[Abstract][Full Text]
Zijlstra, F., de Boer, M. J., Hoorntje, J., Reiffers, S., Reiber, J., Suryapranata, H.
(1993). A Comparison of Immediate Coronary Angioplasty with Intravenous Streptokinase in Acute Myocardial Infarction. NEJM
328: 680-684
[Abstract][Full Text]
Gibbons, R. J., Holmes, D. R., Reeder, G. S., Bailey, K. R., Hopfenspirger, M. R., Gersh, B. J., The Mayo Coronary Care Unit and Catheterization La,
(1993). Immediate Angioplasty Compared with the Administration of a Thrombolytic Agent Followed by Conservative Treatment for Myocardial Infarction. NEJM
328: 685-691
[Abstract][Full Text]
Eckman, M. H., Wong, J. B., Salem, D. N., Pauker, S. G.
(1992). Direct Angioplasty for Acute Myocardial Infarction: A Review of Outcomes in Clinical Subsets. ANN INTERN MED
117: 667-676
[Abstract]
Tcheng, J. E., Jackman, J. D. Jr., Nelson, C. L., Gardner, L. H., Smith, L. R., Rankin, J. S., Califf, R. M., Stack, R. S.
(1992). Outcome of Patients Sustaining Acute Ischemic Mitral Regurgitation during Myocardial Infarction. ANN INTERN MED
117: 18-24
[Abstract]
Cragg, D. R., Friedman, H. Z., Bonema, J. D., Jaiyesimi, I. A., Ramos, R. G., Timmis, G. C., O'Neill, W. W., Schreiber, T. L.
(1991). Outcome of Patients with Acute Myocardial Infarction Who Are Ineligible for Thrombolytic Therapy. ANN INTERN MED
115: 173-177
[Abstract]
Christian, T. F., Clements, I. P., Behrenbeck, T., Huber, K. C., Chesebro, J. H., Gersh, B. J., Gibbons, R. J.
(1991). Limitations of the Electrocardiogram in Estimating Infarction Size after Acute Reperfusion Therapy for Myocardial Infarction. ANN INTERN MED
114: 264-270
[Abstract]
Asonuma, H., Tanji, Y., Nakatoh, H., Nakajima, T., Akita, H., Sasaki, A., Shoji, K.
(1990). Successful Direct PTCA on LAD after First Episode of Acute Myocardial Infarction: Does It Improve Cardiac Function?. ANGIOLOGY
41: 724-730
[Abstract]
Holmes, D. R. Jr, Vlietstra, R. E.
(1989). Balloon Angioplasty in Acute and Chronic Coronary Artery Disease. JAMA
261: 2109-2115
[Abstract]
Popma, J. J., Dehmer, G. J.
(1989). Care of the Patient after Coronary Angioplasty. ANN INTERN MED
110: 547-559
[Abstract]
Gore, J. M., Corrao, J. M., Goldberg, R. J., Ball, S. P., Weiner, B. H., Aghababian, R. V., Dalen, J. E.
(1989). Feasibility and Safety of Emergency Interhospital Transport of Patients During Early Hours of Acute Myocardial Infarction. Arch Intern Med
149: 353-355
[Abstract]
Topol, E. J.
(1988). Coronary Angioplasty for Acute Myocardial Infarction. ANN INTERN MED
109: 970-980
[Abstract]
LEE, T. H., GOLDMAN, L.
(1988). The Coronary Care Unit Turns 25: Historical Trends and Future Directions. ANN INTERN MED
108: 887-894
[Abstract]
PATEL, B., KLONER, R. A., PRZYKLENK, K., BRAUNWALD, E.
(1988). Postischemic Myocardial "Stunning": A Clinically Relevant Phenomenon. ANN INTERN MED
108: 626-628
[Abstract]
Miller, P. F., Brodie, B. R., Weintraub, R. A., LeBauer, E. J., Katz, J. D., Stuckey, T. D., Hansen, C. J.
(1987). Emergency Coronary Angioplasty for Acute Myocardial Infarction: Results From a Community Hospital. Arch Intern Med
147: 1565-1570
[Abstract]
Previous
