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Intervention May Benefit Trial-Ineligible Heart Patients

Last Updated: October 15, 2009.

In patients with ST-elevation myocardial infarction who are usually excluded from randomized controlled trials, primary percutaneous coronary intervention is associated with a lower rate of in-hospital death than thrombolytic therapy, according to a study in the Oct. 15 issue of the American Journal of Cardiology.

THURSDAY, Oct. 15 (HealthDay News) -- In patients with ST-elevation myocardial infarction who are usually excluded from randomized controlled trials, primary percutaneous coronary intervention is associated with a lower rate of in-hospital death than thrombolytic therapy, according to a study in the Oct. 15 issue of the American Journal of Cardiology.

Oliver Koeth, M.D., of Herzzentrum Ludwigshafen in Germany, and colleagues compared outcomes in 11,806 patients who were eligible for enrollment in trials and 9,369 patients who were deemed ineligible because of age at or above 75 years, prehospital delay of more than 12 hours, prehospital cardiopulmonary resuscitation, cardiogenic shock, impaired renal function, or previous stroke.

Compared to eligible patients, the researchers found that ineligible patients had higher rates of in-hospital death (20.1 versus 4.9 percent) and nonfatal strokes (1.5 versus 0.4 percent). They also found that ineligible patients who received early reperfusion therapy had a decreased risk of in-hospital death (odds ratio, 0.62), and that primary percutaneous coronary intervention was associated with the greatest benefit (odds ratio, 0.52).

"Therefore, primary percutaneous coronary intervention seems the preferred reperfusion strategy in these high-risk patients and all efforts should be made to establish a network between hospitals with and without angioplasty facilities to improve hospital and transportation logistics to keep the time loss from admission to primary percutaneous coronary intervention as short as possible," the authors conclude. "However, if primary percutaneous coronary intervention cannot be performed within three hours, thrombolysis is still a valid option."

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