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Previous Volume 346:957-966 March 28, 2002 Number 13 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Perspective by Lange, R. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background As compared with thrombolytic therapy, primary percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction reduces the rates of death, reinfarction, and stroke, but recurrent ischemia, restenosis, and reocclusion of the infarct-related artery remain problematic. When used in combination with PTCA, coronary stenting and platelet glycoprotein IIb/IIIa inhibitors may further improve outcomes.

Methods Using a 2-by-2 factorial design, we randomly assigned 2082 patients with acute myocardial infarction to undergo PTCA alone (518 patients), PTCA plus abciximab therapy (528), stenting alone with the MultiLink stent (512), or stenting plus abciximab therapy (524).

Results Normal flow was restored in the target vessel in 94.5 to 96.9 percent of patients and did not vary according to the reperfusion strategy. At six months, the primary end point — a composite of death, reinfarction, disabling stroke, and ischemia-driven revascularization of the target vessel — had occurred in 20.0 percent of patients after PTCA, 16.5 percent after PTCA plus abciximab, 11.5 percent after stenting, and 10.2 percent after stenting plus abciximab (P<0.001). There were no significant differences among the groups in the rates of death, stroke, or reinfarction; the difference in the incidence of the primary end point was due entirely to differences in the rates of target-vessel revascularization (ranging from 15.7 percent after PTCA to 5.2 percent after stenting plus abciximab, P<0.001). The rate of angiographically established restenosis was 40.8 percent after PTCA and 22.2 percent after stenting (P<0.001), and the respective rates of reocclusion of the infarcted-related artery were 11.3 percent and 5.7 percent (P=0.01), both independent of abciximab use.

Conclusions At experienced centers, stent implantation (with or without abciximab therapy) should be considered the routine reperfusion strategy.

Source Information

From the Cardiovascular Research Foundation and Lenox Hill Heart and Vascular Institute, New York (G.W.S., A.J.L.); William Beaumont Hospital, Royal Oak, Mich. (C.L.G.); Mid Carolina Cardiology, Charlotte, N.C. (D.A.C.); Hospital Gregorio Maranon, Madrid, Spain (E.G.); Duke Clinical Research Institute, Durham, N.C. (J.E.T.); Virginia Beach General Hospital, Virginia Beach, Va. (J.J.G.); Ospedali Riuniti di Bergamo, Bergamo, Italy (G.G.); Moses Cone Memorial Hospital, Greensboro, N.C. (T.S.); Doylestown Hospital, Doylestown, Pa. (M.T.); University of Colorado Health Sciences Center, Denver (J.D.C.); and St. Luke's Hospital, Kansas City, Mo. (B.D.R.).

Address reprint requests to Dr. Stone at the Cardiovascular Research Foundation, 55 E. 59th St., 6th Fl., New York, NY 10022, or at gstone{at}crf.org.

Full Text of this Article

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Comparison of Angioplasty with Stenting in Acute Myocardial Infarction
Herrmann H. C., Stone G. W., Grines C. L., Tcheng J. E.
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N Engl J Med 2002; 347:367-368, Aug 1, 2002. Correspondence

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