Pre-hospital fibrinolysis followed by angioplasty or primary angioplasty in acute myocardial infarction:: The long-term clinical outcome

Background: Randomized trials comparing primary angioplasty and in-hospital fibrinolysis in acute myocardial infarction ( AMI) have shown an advantage for primary angioplasty. The long-term follow-up of pre-hospital fibrinolysis followed by elective or rescue coronary angioplasty versus primary angioplasty is not well established after acute myocardial infarction. This study sought to assess the long-term clinical outcome of patients with AMI having either received pre-hospital fibrinolysis optimized by coronary angioplasty or primary angioplasty. Methods: We conducted a retrospective analysis involving 318 patients who either underwent primary angioplasty (n = 157) or received pre-hospital fibrinolysis followed by an angioplasty ( rescue or elective) (n = 161) within 6 hours of the onset of chest pain. Results: The groups were similar regarding their baseline characteristics except for the ages. No difference was noted for in-hospital mortality ( primary PTCA group: 2.48%, combined group: 2.54%; p = ns) with no increased risk of hemorrhage. The 3-year mortality was not significantly different in the two groups (9.7% vs. 4.9%; p = 0.15). Regarding major adverse cardiac events (29.5% vs. 37.5%; p = 0.23), reintervention (22.5% vs. 23.2%; p = 0.99) or target lesion revascularization (16.1% vs. 14.7%; p= 0.68), the groups were statistically similar. Conclusion: These data from real-life practice emphasize the safety and similar benefits on the long-term clinical outcome of AMI patients having undergone either pre-hospital fibrinolysis followed by angioplasty or primary angioplasty.