1989

Demonstration That Percutaneous Transvenous Coronary Angioplasty (PTCA) Was Superior to Thrombolysis in STEMI

Early trials comparing PTCA (ballooning and stenting) with IV thrombolysis (streptokinase or recombinant tissue plasminogen activator) demonstrated the superiority of PTCA. In 1997, a 10-trial meta-analysis demonstrated that 30-day mortality was 4.4 percent with PTCA versus 6.5 percent with early thrombolysis.⁴ Most of the studies were very small in size, with GUSTO-IIb, published in 1997, being the largest (565 patients of the 2,606 total patients in the 10 randomized controlled trials).⁵

Dr. Bukata is executive editor of Emergency Medical Abstracts and clinical professor of emergency medicine at the Keck School of Medicine of the University of Southern California in Los Angeles.

References

1. Hughes KE, Lewis SM, Katz L, et al. Safety of computer interpretation of normal triage electrocardiograms. Acad Emerg Med. 2017;24(1):120-124.
2. Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Gruppo Italiano per lo Studio della Streptochinasi nell‘Infarto Miocardico (GISSI). Lancet. 1986;1(8478):397-402.
3. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet. 1988;2(8607):349-360.
4. Weaver WD, Simes RJ, Betriu A, et al. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA. 1997;278(23):2093-2098.
5. The Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) Angioplasty Substudy Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N Engl J Med. 1997;336:1621-1628.

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