Long-term outcome after primary angioplasty: report from the Primary Angioplasty in Myocardial Infarction (PAMI-I) trial

OBJECTIVES This study sought to compare the two-year outcome after primary percutaneous coronary angioplasty or thrombolytic therapy for acute myocardial infarction. BACKGROUND Primary angioplasty, that is, angioplasty without antecedent thrombolytic therapy, has been shown to be an effective reperf...

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Published in:Journal of the American College of Cardiology 1999-03, Vol.33 (3), p.640-646
Main Authors: Nunn, Christopher M., O’Neill, William W., Rothbaum, Donald, Stone, Gregg W., O’Keefe, James, Overlie, Paul, Donohue, Bryan, Grines, Lorelei, Browne, Kevin F., Vlietstra, Ronald E., Catlin, Tom, Grines, Cindy L.
Format: Article
Language:English
Subjects:
Angioplasty, Balloon, Coronary
Biological and medical sciences
Cardiology. Vascular system
Coronary Angiography
Coronary heart disease
Female
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - therapeutic use
Follow-Up Studies
Heart
Humans
Infusions, Intravenous
Male
Medical sciences
Middle Aged
Myocardial Infarction - diagnostic imaging
Myocardial Infarction - therapy
Prospective Studies
Recurrence
Tissue Plasminogen Activator - administration & dosage
Tissue Plasminogen Activator - therapeutic use
Treatment Outcome
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Summary:OBJECTIVES This study sought to compare the two-year outcome after primary percutaneous coronary angioplasty or thrombolytic therapy for acute myocardial infarction. BACKGROUND Primary angioplasty, that is, angioplasty without antecedent thrombolytic therapy, has been shown to be an effective reperfusion modality for patients suffering an acute myocardial infarction. This report reviews the two-year clinical outcome of patients randomized in the Primary Angioplasty in Myocardial Infarction trial. METHODS At 12 clinical centers, 395 patients who presented within 12 h of the onset of myocardial infarction were randomized to undergo primary angioplasty (195 patients) or to receive tissue-type plasminogen activator (t-PA) (200 patients) followed by conservative care. Patients were followed by physician visits, phone call, letter and review of hospital records for any hospital admission at one month, six months, one year and two years. RESULTS At two years, patients undergoing primary angioplasty had less recurrent ischemia (36.4% vs. 48% for t-PA, p = 0.026), lower reintervention rates (27.2% vs. 46.5% for t-PA, p < 0.0001) and reduced hospital readmission rates (58.5% vs. 69.0% for t-PA, p = 0.035). The combined end point of death or reinfarction was 14.9% for angioplasty versus 23% for t-PA, p = 0.034. Multivariate analysis found angioplasty to be independently predictive of a reduction in death, reinfarction or target vessel revascularization (p = 0.0001). CONCLUSIONS The initial benefit of primary angioplasty performed by experienced operators is maintained over a two-year follow-up period with improved infarct-free survival and reduced rate of reintervention.
ISSN:0735-1097
1558-3597
DOI:10.1016/S0735-1097(98)00622-6