0
Communications to the Editor |

Fibrinolysis or Angioplasty in Acute Myocardial Infarction? Fibrinolysis or Angioplasty in Acute Myocardial Infarction? FREE TO VIEW

Gérard Helft, MD, PhD; Farzin Beygui, MD; Stephen G. Worthley, MBBS, PhD
Author and Funding Information

Affiliations: Hôpital Necker Paris, France Monash Medical Centre Melbourne, Victoria, Australia,  University of North Carolina at Chapel Hill Chapel Hill, NC

Correspondence to: Gérard Helft, MD, PhD, Clinique Cardiologique, Hôpital Necker, 149 rue de Sevres, Paris 75743, France; e-mail: gerard.helft@nck-ap-hop-paris.fr



Chest. 2001;120(5):1747. doi:10.1378/chest.120.5.1747
Text Size: A A A
Published online

To the Editor:

We read with interest the chapter entitled “Intravenous Thrombolysis in Acute Myocardial Infarction” in the Sixth ACCP Consensus Conference on Antithrombotic Therapy (January 2001).1 In the recommendations, it is stated “that patients with ischemic symptoms characteristic of acute MI [myocardial infarction] for < 12 h who have ST-segment elevation or left bundle-branch block on the ECG should receive IV fibrinolytic therapy unless they have contraindications (grade IA).”1No mention of primary angioplasty has been made. Interestingly, in the previous recommendations (the Fifth ACCP Consensus Conference on Antithrombotic Therapy), it was stated that “either thrombolytic therapy or urgent angiography and PTCA [percutaneous transluminal coronary angioplasty] (primary angioplasty) should be considered for every patient with acute evolving MI for the reduction of mortality.”2How must this significant change in the new recommendations be interpreted? Does it suggest that primary angioplasty is no longer considered as an alternative option? On the contrary, there is growing evidence that primary angioplasty is an excellent alternative in experienced centers.3Moreover, it has been shown that primary angioplasty confers a long-term benefit, compared to thrombolytic therapy, for acute MI.4 Therefore, without entering into the debate between which management option is most appropriate, fibrinolysis or primary angioplasty, we think it should have been stated in the recent consensus document that primary angioplasty is another option (with grade 1A evidence) in acute MI.

Ohman, EM, Harrington, RA, Cannon, CP, et al (2001) Intravenous thrombolysis in acute myocardial infarction.Chest119,253S-277S. [PubMed] [CrossRef]
 
Cairns, JA, Kennedy, JW, Fuster, V Coronary thrombolysis.Chest1998;114,634S-675S. [PubMed]
 
Weaver, WD, Simes, RJ, Betriu, A, et al Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review.JAMA1997;278,2093-2098. [PubMed]
 
Zijlstra, F, Hoorntje, JCA, de Boer, MJ, et al Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction.N Engl J Med1999;341,1413-1419. [PubMed]
 

Fibrinolysis or Angioplasty in Acute Myocardial Infarction?

To the Editor:

We felt that discussing primary angioplasty vs thrombolysis was outside the scope of our review. We had opted to discuss only the pharmacologic therapies in detail. Nevertheless, I think Dr. Helft makes a good point that, at some point in the consensus document, we should make a reference to primary angioplasty and appropriate pharmacologic therapies. Currently, there is some information regarding antithrombotic therapy in primary angioplasty in the section on antithrombotic therapy for angioplasty.

I appreciate you bringing this to our attention, and I trust that you agree with our strategy of discussing the pharmacologic therapies rather than relative merits of different strategies for reperfusion. Those are well covered in the AHA guidelines for ST elevation (www.americanheart.org).


Figures

Tables

References

Ohman, EM, Harrington, RA, Cannon, CP, et al (2001) Intravenous thrombolysis in acute myocardial infarction.Chest119,253S-277S. [PubMed] [CrossRef]
 
Cairns, JA, Kennedy, JW, Fuster, V Coronary thrombolysis.Chest1998;114,634S-675S. [PubMed]
 
Weaver, WD, Simes, RJ, Betriu, A, et al Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review.JAMA1997;278,2093-2098. [PubMed]
 
Zijlstra, F, Hoorntje, JCA, de Boer, MJ, et al Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction.N Engl J Med1999;341,1413-1419. [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543