Heart 1997;78:323-324 ( October )
Editorial
Transferring patients for primary angioplasty
| The first 150 words of the full text of this article appear below. |
The success of fibrinolysis in the treatment of myocardial
infarction has been attributed to reperfusion of the occluded vessel, however, it has become clear that it is not just reperfusion but restoration of normal flow
defined angiographically as TIMI-3 flowin
the infarct related artery that dictates mortality. Analysis of the
different treatment arms of GUSTO-I,1 the PAMI
trials,2,3 and the primary angioplasty
registry,4 demonstrates a very clear inverse linear
relation between mortality and the rate of TIMI-3 flow achieved in the
infarct related artery. The randomised trials of primary angioplasty in
acute infarction2,5,6 all point to it being superior to
thrombolytic therapy in achieving this goal, although in the GUSTO-IIB
substudy7 the benefit was less marked.
The trials of thrombolytic therapy versus placebo all demonstrated a
time dependent benefit, the shortest "pain to needle" times having
the lowest mortality with a cut off at approximately six hours. This
has
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