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STEMI Cardiac Outcomes Better With Primary PCI

Compared to thrombolysis, twice as likely to prevent composite cardiac death/recurrent MI

THURSDAY, Dec. 23 (HealthDay News) -- Following an ST-segment elevation myocardial infarction (STEMI), patients treated with primary percutaneous coronary intervention (PPCI), along with the newer, adjunctive therapies enoxaparin and abciximab, have a lower combined mortality and recurrent myocardial infarction (MI) rate than those treated with thrombolytic therapy, according to a study published in the Dec. 15 issue of The American Journal of Cardiology.

Mikael Aasa, M.D., Ph.D., of Sodersjukhuset in Stockholm, Sweden, and colleagues reviewed data from the Swedish national registries to compare the long-term (greater than five years) survival rates following a STEMI for 205 patients treated at seven hospitals. PPCI was performed and enoxaparin and abciximab were administered to 101 patients. The others received thrombolytic therapy: reteplase and enoxaparin. Forty two percent of patients from both groups started anticoagulation or thrombolytic treatment before arriving at the hospital. Drug eluting stents were not available during the period studied.

The investigators found that patients treated with PPCI -- preferably with stenting and enoxaparin and abciximab -- were much less likely to suffer the composite outcome of cardiac-related death or recurrent MI than were those in the thrombolysis group (hazard ratio, 0.54). However, a statistically significant benefit was not seen in the composite of total survival or recurrent MI. Patients treated with thrombolytic therapy before arriving at the hospital had outcomes similar to those in the PPCI group.

"PPCI in combination with enoxaparin and abciximab compares favorably to thrombolysis in combination with enoxaparin with a risk decrease that stretches beyond the early postinfarction period. Prehospital thrombolysis may, however, match PPCI in long-term outcome," the authors write.

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