| Randomized comparison of primary coronary angioplasty with thrombolytic therapy in low risk patients with acute myocardial infarction. | |
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MedLine Citation:
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PMID: 9120174 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We sought to compare primary coronary angioplasty and thrombolysis as treatment for low risk patients with an acute myocardial infarction. BACKGROUND: Primary coronary angioplasty is the most effective reperfusion therapy for patients with acute myocardial infarction; however, intravenous thrombolysis is easier to apply, more widely available and possibly more appropriate in low risk patients. METHODS: We stratified 240 patients with acute myocardial infarction at admission according to risk. Low risk patients (n = 95) were randomized to primary angioplasty or thrombolytic therapy. The primary end point was death, nonfatal stroke or reinfarction during 6 months of follow-up. Left ventricular ejection fraction and medical charges were secondary end points. High risk patients (n = 145) were treated with primary angioplasty. RESULTS: In low risk patients, the incidence of the primary clinical end point (4% vs. 20%, p < 0.02) was lower in the group with primary coronary angioplasty than in the group with thrombolysis, because of a higher rate of reinfarction in the latter group. Mortality and stroke rates were low in both treatment groups. There were no differences in left ventricular ejection fraction or total medical charges. High risk patients had a 14% incidence rate of the primary clinical end point. CONCLUSIONS: Simple clinical data can be used to risk-stratify patients during the initial admission for myocardial infarction. Even in low risk patients, primary coronary angioplasty results in a better clinical outcome at 6 months than does thrombolysis and does not increase total medical charges. |
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Authors:
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F Zijlstra; W P Beukema; A W van 't Hof; A Liem; S Reiffers; J C Hoorntje; H Suryapranata; M J de Boer |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 29 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1997 Apr |
Date Detail:
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Created Date: 1997-04-24 Completed Date: 1997-04-24 Revised Date: 2007-09-04 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 908-12 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, Hospital De Weezenlanden, Zwolle, The Netherlands. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary* Female Fibrinolytic Agents / therapeutic use Humans Male Middle Aged Myocardial Infarction / drug therapy, physiopathology, therapy* Risk Assessment Streptokinase / therapeutic use Stroke Volume Thrombolytic Therapy* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; EC 3.4.-/Streptokinase |
| Comments/Corrections | |
Comment In:
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ACP J Club. 1997 Nov-Dec;127(3):59 J Am Coll Cardiol. 1997 Apr;29(5):913-4 [PMID: 9120175 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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