Comparison of Outcomes between Primary Percutaneous Transluminal Coronary Angioplasty(PTCA) and Thrombolysis with Delayed PTCA in Patients with Acute Myocardial Infarction: Single Center Experience

Kim, Hyun Joong; Kwon, Sung Uk; Jung, Jin Ok; Gwon, Hyeon Cheol; Park, Seung Woo; Kim, June Soo; Kim, Duk Kyung; Lee, Sang Hoon; Hong, Kyung Pyo; Park, Jeong Euy; Seo, Jung Don; Lee, Won Ro

Abstract

BACKGROUND AND OBJECTIVES: Many western studies have shown that primary percutaneous transluminal coronary angioplasty (PTCA) may have better clinical result over thrombolytic therapy in patients with acute myocardial infarction. There are, however, few reports about the role of primary PTCA in Korea. We reviewed the cases of primary PTCA and thrombolysis with delayed PTCA in Samsung Medical Center to compare the clinical outcomes of two treatment modalities. MATERIALS AND METHOD: This study was a non-randomized and retrospective trial. From August 1995 to March 1998, 80 AMI patients within 12 hours of symptom onset underwent primary PTCA (n=26) or thrombolytic therapy (n=54) in Samsung Medical Center. Patients who had thrombolysis were performed coronary angiography fourth to fifth hospital day routinely. Risk factors and time to treatment (pain-to-needle time and door- to-needle time) were reviewed from patient record. Angiographic data including TIMI flow were obtained from angiography data base and angiographic film. We compared the 30-day and 8-month event rate of death, re-infarction, re-PTCA, and CABG between two groups.
RESULTS
Baseline characteristics (sex, age, blood pressure, heart rate, AMI location, ejection fraction of left ventricle) were similar between two groups. There was no statistically significant difference in pain-to-needle time and door-to-needle time between two groups. The 30-day mortality rate was similar between two groups (primary group 3.8%, thrombolysis 5.6%, p=1.0). The 30-day event rate also showed no difference between two groups (primary PTCA 7.7%, thrombolysis 11.1%, p=1.0) and there was similar tendency in 8-month event rate (primary PTCA 19.2%, thrombolysis 14.8%, p=0.62). However, the admission duration of primary PTCA group was shorter than that of thrombolysis (8.7 vs 12 days, p=0.03).
CONCLUSION
Primary PTCA have similar clinical outcome except shorter hospital admission duration when compared to thrombolysis with routine elective coronary angiography and delayed PTCA in AMI patients without cardiogenic shock.