Primary angioplasty reduces risk of myocardial rupture compared to thrombolysis for acute myocardial infarction

James W. Kinn, William W. O'Neill, Keith H. Benzuly, Denise E. Jones, Cindy L. Grines*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

61 Scopus citations

Abstract

Although the mechanical complications of acute ventricular septal detect and acute mitral regurgitation are uncommon after acute myocardial infarction, these complications are associated with an extremely high morbidity and mortality. We hypothesized that the administration of thrombolytic drugs may result in hemorrhagic infarction as well as the potential for incomplete revascularization and thus may lead to an increased incidence of mechanical complications compared to primary angioplasty. Accordingly, we reviewed the data of the most contemporary thrombolytic and primary angioplasty trials and compared the incidence of mechanical complications among 36,303 patients treated with thrombolytics reported in the GUSTO trial to the incidence of mechanical complications among 1,295 patients treated with primary angioplasty obtained from the PAMI-1 and PAMI- 2 trials. We found that angioplasty resulted in an overall 86% relative risk reduction in mechanical complications (2.20% vs. 0.31%, P < 0.001). In comparison to thrombolytic therapy, angioplasty resulted in an 82% decrease in acute mitral regurgitation (1.73% vs. 0.31%, P < 0.001) and a 100% decrease in acute ventricular septal defect (0.47% vs. 0.00%, P < 0.03). In conclusion, in patients with acute myocardial infarction, reperfusion with primary angioplasty is associated with less myocardial rupture and mechanical complications than thrombolytics. This finding may, in part, explain the improved prognosis observed in myocardial infarction patients treated with primary angioplasty.

Original languageEnglish (US)
Pages (from-to)151-157
Number of pages7
JournalCatheterization and Cardiovascular Diagnosis
Volume42
Issue number2
DOIs
StatePublished - Oct 1 1997

Keywords

  • Acute myocardial infarction
  • Angioplasty
  • Mechanical complications
  • Myocardial rupture
  • Reperfusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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