Primary Percutaneous Transluminal Coronary Intervention Compared with Intravenous Thrombolysis in Patients with ST Segment Elevation Myocardial Infarction
Wiwun Tungsubutra MD*, Damras Tresukosol MD*, Rungroj Krittayaphong MD*, Pradit Panchavinnin MD*, Rewat Phankingtongkhum MD*, Chunhakasem Chotnaiwattarakul MD**
Affiliation : * Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University ** Her Majesty Cardiac Center, Faculty of Medicine, Siriraj Hospital, Mahidol University
Background : Primary percutaneous transluminal coronary intervention (PCI) and thrombolytic therapy
(TT) are alternative means of achieving reperfusion in patients with acute ST segment elevation myocardial
infarction (STEMI).
Objective : To compare the outcomes between both reperfusion strategies. The authors sought to compare in-
hospital outcomes after PCI or TT for patients with acute STEMI.
Materials and Methods : From August 2002 through June 2004, data from all patients who received reperfusion
therapy for acute STEMI were collected prospectively. The decision regarding type of reperfusion strategy was
at the attending cardiologist’s discretion. The patient’s data on demographics, procedures, medications, and
in-hospital outcomes were analyzed.
Results : From August 2002 through June 2004, 234 patients were admitted to the authors’ institute with the
diagnosis of acute STEMI. Of the 146 patients who received reperfusion therapy, 91 were treated with primary
PCI and 55 received intravenous TT as the reperfusion modality. In the TT group, 51 (93%) patients received
streptokinase and 11 (21.6%) underwent rescue angioplasty. The two groups had similar baseline character-
istics. Both patient groups had frequent presence of diabetes (PCI 44.2% vs. TT 39.6%, p = 0.6). Cardiogenic
shock on admission was present in 11% of the PCI patients and 7.3% of the TT patients (p = ns). In-hospital
mortality was not significantly different in the two groups (PCI 14.3% vs. TT 10.9%, p = 0.56). In the TT group,
there was a trend toward a higher rate of major bleeding (PCI 6.6% vs. TT 16.4%, p = 0.06) and stroke (PCI
2.2% vs. TT 7.3%, p = 0.13) complications without statistical significance.
Conclusion : The present findings suggest that both PCI and TT are comparable alternative methods of
reperfusion among STEMI patients in terms of in-hospital mortality. In certain subgroups that are at increased
risk of bleeding or stroke, primary PCI may be the preferred treatment strategy.
Keywords : Acute coronary syndrome, Acute myocardial infarction, Primary angioplasty, Thrombolysis
