Many trials have been done to compare balloon angioplasty with intravenous medical therapy to improve reperfusion (restoration of coronary artery blood flow to the heart) for patients with a specific heart-attack profile called acute ST-segment elevation myocardial infarction.
Ellen Keeley from the University of Texas Southwestern Medical Center, USA, and colleagues assessed the combined results of 23 trials (which collectively involved around 7700 patients) to ascertain which reperfusion therapy was most effective.
Angioplasty was better in the short term (four to six weeks follow-up) at reducing short-term death (7% compared with 9% for medical therapy), recurrence of non-fatal heart attack (3% compared with 7%), stroke (1% compared with 2%), and a combination of all these outcomes (8% compared with 14%). These differences were sustained for longer-term follow-up (six to eighteen months).
Ellen Keeley comments: "Our findings indicate that primary angioplasty is better than thrombolytic therapy at reducing short-term major adverse cardiac events, including death in individuals with ST-segment elevation acute myocardial infarction. Furthermore, these favourable results are sustained during long-term follow-up. Primary PTCA was associated with better clinical outcomes than thrombolytic therapy irrespective of the type of thrombolytic regimen used, and even when reperfusion was delayed because of transfer for primary PTCA."
Journal
The Lancet