Primary Angioplasty No Better Than Prehospital Thrombolytic Therapy

Primary angioplasty is not more effective than prehospital thrombolytic therapy for acute myocardial infarction (MI), according to the results of a randomized trial reported in the Sept. 14 issue of The Lancet.

“Although both prehospital fibrinolysis and primary angioplasty provide a clinical benefit over in-hospital fibrinolysis in acute MI, they have not been directly compared,” write Eric Bonnefoy, MD, and colleagues from University Hospital in Lyon, France.

This multicenter trial studied 840 patients who presented within six hours of acute MI with ST-segment elevation and who were initially managed by mobile emergency care units. Patients were randomized to prehospital fibrinolysis with alteplase or to emergency angioplasty on arrival to the hospital. All patients were transferred to a center with access to emergency angioplasty, and 26% of patients assigned to prehospital fibrinolysis failed this treatment and had rescue angioplasty.

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