A Comparison of Thrombolytic Therapy and Primary Angioplasty in Patients with Acute Myocardial Infarction

Background and Objective: The standard treatment for patients with acute myocardial infarction is to reestablish blood flow in the blocked vessels, which is possible through angioplasty and thrombolytic therapy. However, even in developed countries, some patients still do not undergo coronary interventional therapy due to difficulties in accessing centers capable of performing primary angioplasty and the lack of prepared angiography departments, which can lead to undesirable consequences. Therefore, this study was conducted to compare the therapeutic outcomes of primary angioplasty and thrombolytic therapy. Methods: This cross-sectional study was conducted on 291 patients with ST segment elevation myocardial infarction (STEMI) referred to medical centers under the auspices of Babol University of Medical Sciences. Patients undergoing Primary Percutaneous Coronary Intervention (PPCI) (n=213) or thrombolytic therapy (n=78) were evaluated and compared in terms of demographic and clinical information at the time of referral, mortality rate, major cardiovascular events, need for repeat PCI, and need for readmission. Findings: The mean age of the patients was 60.55±11.90 years and 72% of the patients were male. Repeat single-vessel PCI was 11% (6 cases) in the Primary Percutaneous Coronary Intervention (PPCI) group and 23% (7 cases) in the thrombolytic therapy group. Readmission due to chest pain and shortness of breath was 30% (59 cases) in the PPCI group and 39% (38 cases) in the thrombolytic therapy group. The odds of mortality in patients treated with thrombolytic therapy compared to PCI were 1.38 times (p=0.56, OR=1.38), which was not significant. Furthermore, the odds of mortality decreased significantly with increasing EF (p=0.001, OR=14.64). Ejection Fraction (EF) and Functional Class (FC) were not significantly different between the two groups. The average time interval from onset of pain to hospital admission and thrombolytic therapy was 276±147 and 33±5 minutes, respectively, and in the PCI group it was 323±169 and 37±6 minutes, respectively. The odds of recurrent myocardial infarction (MI) in patients treated with thrombolytic therapy were 1.53 times higher than in patients treated with PPCI (OR=1.53, p=0.54), which was not significant. Conclusion: According to the results of this study, treatment outcomes in both groups were better if the patient had visited the hospital within a short time from the onset of pain. The rate of recurrent MI and single