Editorial
Immediate angioplasty for the National Health Service?
| The first 150 words of the full text of this article appear below. |
In-hospital
fatality from acute myocardial infarction remains high. Precisely how
high depends on the way data are collected, and on what patients are
included. While clinical trials of thrombolysis suggest that the case
fatality rate should be around 7%, registry data suggest that the true
"real world" rate (which includes many elderly patients) is much
more like 20%. Gitt and Senges1 argue that the high death
rate results from failure to use thrombolysis, and that as it will be
difficult to improve on current thrombolysis rates the way forward is
to increase the use of immediate, or primary, angioplasty. If this
strategy is correct, the implications for the National Health Service
are enormous. There is evidence that hospitals with a higher volume of
angioplasty procedures show a lower fatality rate among patients
undergoing primary angioplasty, and the American College of
Cardiology/American Heart Association (ACC/AHA)
guidelines2 suggest that primary angioplasty should
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