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We have read the article with great interest. Selection of the 23
patients is not clearly mentioned here. There is a lack of some other
information too. Once the chest pain started, after what time those
patients were selected for angioplasty? What was the percentage of lumen
narrowing or stenosis? Was the stenosis complicated or not? What was the
material used for primary angioplasty?
Rapid time to treatment with thrombolytic therapy is associated with
lower mortality in patients with acute myocardial infarction (MI). Study suggests that physicians and health care systems should work to
minimize door-to-balloon times and that door-to-balloon time should be
considered when choosing a reperfusion strategy. Time from acute MI
symptom onset to first balloon inflation and by time from hospital arrival
to first balloon inflation (door-to-balloon time) plays an important role
in management of MI.
In a study showed that, patients with AMI treated at hospitals
with high or intermediate volumes of primary angioplasty had lower
mortality with primary angioplasty than with thrombolysis, whereas
patients with AMI treated at hospitals with low angioplasty volumes had
similar mortality outcomes with primary angioplasty or thrombolysis. To
prevent restenosis or reinfarction in previously stenosed coronary vessels
drug eluting stent (paclitaxel-eluting stent) proves superior to bare
metal stent. In patients with in-stent restenosis, sirolimus- or
paclitaxel-eluting stents is superior to conventional balloon angioplasty
for the prevention of recurrent restenosis. Sirolimus-eluting stents may
be superior to paclitaxel-eluting stents for treatment of this disorder.
1. Should primary angioplasty be available for all patients with an ST
elevation myocardial infarction? A de Belder. Heart 2005;91:1509-1511;
2. Christopher P. Cannon; C. Michael Gibson; Costas T. Lambrew; David A.
Shoultz; Drew Levy; William J. French; Joel M. Gore; W. Douglas Weaver;
William J. Rogers; Alan J. Tiefenbrunn
Relationship of Symptom-Onset-to-Balloon Time and Door-to-Balloon Time
With Mortality in Patients Undergoing Angioplasty for Acute Myocardial
JAMA, Jun 2000; 283: 2941 - 2947.
3. David J. Magid; B. Ned Calonge; John S. Rumsfeld; John G. Canto; Paul
D. Frederick; Nathan R. Every; Hal V. Barron; for the National Registry of
Myocardial Infarction 2 and 3 Investigators
Relation Between Hospital Primary Angioplasty Volume and Mortality for
Patients With Acute MI Treated With Primary Angioplasty vs Thrombolytic
JAMA, Dec 2000; 284: 3131 - 3138.
4. Gregg W. Stone; Stephen G. Ellis; Louis Cannon; J. Tift Mann; Joel D.
Greenberg; Douglas Spriggs; Charles D. O'Shaughnessy; Samuel DeMaio;
Patrick Hall; Jeffrey J. Popma; Joerg Koglin; Mary E. Russell; for the
TAXUS V Investigators
Comparison of a Polymer-Based Paclitaxel-Eluting Stent With a Bare Metal
Stent in Patients With Complex Coronary Artery Disease: A Randomized
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5. Adnan Kastrati; Julinda Mehilli; Nicolas von Beckerath; Alban Dibra;
Jörg Hausleiter; Jürgen Pache; Helmut Schühlen; Claus Schmitt; Josef
Dirschinger; Albert Schömig; for the ISAR-DESIRE Study Investigators
Sirolimus-Eluting Stent or Paclitaxel-Eluting Stent vs Balloon Angioplasty
for Prevention of Recurrences in Patients With Coronary In-Stent
Restenosis: A Randomized Controlled Trial. JAMA, January 12, 2005; 293:
165 - 171.