ABSTRACT
Based upon the results of multiple randomized clinical trials in comparison with fibrinolytic therapy, primary coronary intervention, when readily available, has become the ‘default mode’ for management of patients seen within the first 12 hours of myocardial infarction.1-4 This paradigm shift away from front-line use of fibrinolytic therapy is based upon individual and aggregate data summarized in meta-analysis format in Figs 6.1-6.3, as well as the results of the more recently completed DANAMI II Study.5 In formal meta-analysis of 10 randomized trials comparing primary angioplasty with intravenous fibrinolytic therapy involving 2606 patients, Weaver and colleagues noted mortality at 30 days was 4.4% for the angioplasty treated patients compared to 6.5% for the lytic treated patients [odds ratio (OR) is 0.66; 95% confidence intervals (CI) 0.46-0.94; p = 0.02] (Fig. 6.1).4 Angioplasty was also associated with a significant reduction in total stroke (0.7% vs 2.0%; p = 0.007), as well as the risk of recurrent myocardial infarction (MI) (Figs 6.2 and 6.3). Survival curves remained essentially parallel from 2 weeks to 6 months after treatment and the mortality benefit remained at significant at follow-up (p = 0.04) (Fig. 6.4).
