Comparison of effectiveness of primary angioplasty to thrombolysis and its relationship in context time delay: a meta-analysis

Correspondence to: Wojskowy Instytut Higieny i Epidemiologii, ul. Kozielska 4, 01-163 Warszawa, e-mail:
Source of financing: Department own sources

Pediatr Med rodz Vol 5 Numer 2, p. 245-249

Meta-analyses of the various randomised trials comparing thrombolysis and primary angioplasty have demonstrated substantial benefits from angioplasty in terms of mortality, non-fatal re-infarction and stroke, and they have also proved that angioplasty has lower recurrence rates and less residual stenosis. Despite the obvious clinical superiority of primary angioplasty, thrombolytic treatment is the default treatment option in many countries because of practical limitations on the use of percutaneous interventions including e.g. appropriately skilled staff. The choice of proper management also needs to consider the possible time delay in initiating reperfusion with primary angioplasty compared to thrombolysis. Reperfusion therapy has become the unquestionable gold standard for the early management of acute ST-segment elevation coronary syndromes. The advantages of this strategy rises exponentially, if the therapy will be initiated earlier. The highest number of patients saved by reperfusion therapy is within the first hour after symptom onset. The time interval which is creating a window of opportunity has aptly termed the “golden hour”. The mechanism of this benefit relates to maximizing myocardial salvage by early restoration of adequate coronary blood flow, resulting in preservation of left ventricular function, thereby enhancing both early and long-term survival. It is currently uncertain as to how to best handle patients with aborted myocardial infarction. A strong case for coronary angiography with a view to coronary intervention seems convinced, especially if there is a large initial territory of heart at risk. Failure to intervene could attenuate the initial prognostic benefit. The effect of angioplasty-related time delay in reducing the mortality benefit of angioplasty relative to thrombolysis has been demonstrated using metaregression methods.

Keywords: acute myocardial infarction, primary coronary angioplasty, reperfusion therapy, thrombolytics, metaanalysis