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Mortality benefit of primary PCI vs. thrombolytic strategies found reduced
Claeys M. Arch Intern Med. 2011;171:544-549.
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Researchers have reported that the mortality benefit of modern thrombolytic strategies was comparable to primary percutaneous coronary intervention in low- and intermediate-risk patients, but not in those at high risk.
With these findings, the researchers concluded that the absolute mortality benefit of primary PCI has been substantially attenuated.
The study featured 5,295 patients with STEMI who were admitted to 73 Belgian hospitals from 2007 to 2009. Of these patients, 721 received thrombolysis — of whom 603 patients were given subsequent invasive evaluation — and 4,574 were treated with primary PCI. Patients were then separated into three groups based on thrombolysis in MI score: low (n=1,934), intermediate (n=2,382) and high (n=979).
Researchers found no significant difference between in-hospital mortality rates of primary PCI (5.9%) and thrombolysis (6.6%) groups. They then adjusted for baseline risk profile differences and found that primary PCI was beneficial on mortality rate in high-risk patients (23.7% vs. 30.6; P=.03), but not significantly beneficial in low- (0.3% vs. 0.4%) or intermediate-risk (2.9% vs. 3.1%) patients.
“The clinical consequences of our findings may be of particular interest for hospitals with limited urgent access to PCI facilities,” the researchers wrote. “Our findings provide reassurance to physicians at these hospitals that treating patients according to the guidelines (ie, early administration of lytic therapy when PCI is unavailable and planning early angiography) is associated with excellent prognosis in a real-world setting.”
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