Routine Early Angioplasty after Fibrinolysis for Acute Myocardial Infarction

In a randomized trial, 1059 patients with an acute myocardial infarction with ST-segment elevation presented to hospitals that did not have the capability of performing percutaneous coronary intervention (PCI) and received fibrinolysis. They were then assigned to either immediate transfer to a PCI center for catheterization or transfer only if fibrinolysis failed. The immediate-transfer strategy was associated with significantly fewer ischemic complications at 30 days. In patients with an acute myocardial infarction with ST-segment elevation, routine early angioplasty after fibrinolysis was associated with significantly fewer ischemic complications at 30 days. Primary percutaneous coronary intervention (PCI) is an effective treatment for myocardial infarction with ST-segment elevation when it can be performed rapidly. 1 However, primary PCI is performed at less than 25% of acute care hospitals in the United States. 2 , 3 Many patients with myocardial infarction with ST-segment elevation present to hospitals that do not have the capability of performing PCI and therefore cannot undergo PCI within the timelines recommended in the guidelines 4 ; instead, they receive fibrinolysis as the initial reperfusion therapy. Although the proportion of such patients has decreased in recent years, 27.6% of the patients in the National Registry . . .