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KMID : 0368119990290121281
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Korean Circulation Journal
1999 Volume.29 No. 12 p.1281 ~ p.1288
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Comparison of Outcomes between Primary Percutaneous Transluminal Coronary Angioplasty(PTCA) and Thrombolysis with Delayed PTCA in Patients with Acute Myocardial Infarction : Single Center Experience
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1/2김현중/12Hyun Joong Kim
1/2권성욱/1/2정진옥/1/2권현철/1/2박승우/1/2김준수/1/2김덕경/1/2이상훈/1/2홍경표/1/2박정의/1/2서정돈/1/2이원로/12Sung Uk Kwon/12Jin Ok Jung/12Hyeon Cheol Gwon, 12Seung Woo Park/12June Soo Kim/12Duk Kyung Kim/12Sang Hoon Lee/12Kyung Pyo Hong/12Jeong
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Abstract
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Background and Objectives : Many western studies have shown that primary
percutaneous transluminal coronary angioplasty (PTCA) may have better clinical result
over thrombolytic therapy in patients with acute myocardial infarction. There are,
however, few reports about the role of primary PTCA in Korea. We reviewed the cases
of primary PTCA and thrombolysis with delayed PTCA in Samsung Medical Center to
compare the clinical outcomes of two treatment modalities.
Materials and method : This study was a non-randomized and retrospective trial. From
August 1995 to March 1998, 80 AMI patients within 12 hours of symptom onset
underwent primary PTCA (n=26) or thrombolytic therapy (n=54) in Samsung Medical
Center. Patients who had thrombolysis were performed coronary angiography fourth to
fifth hospital day routinely. Risk factors and time to treatment (pain-to-needle time and
door-to-needle time) were reviewed from patient record. Angiographic data including
TIMI flow were obtained from angiography data base and angiographic film. We
compared the 30-day and 8-month event rate of death, re-infarction, re-PTCA, and
CABG between two groups.
Results : Baseline characteristics (sex, age, blood pressure, heart rate, AMI location,
ejection fraction of left ventricle) were similar between two groups. There was no
statistically significant difference in pain-to-needle time and door-to -needle time
between two groups. The 30-day mortality rate was similar between two groups
(primary group 3.8%, thrombolysis 5.6%, p=1.0). The 30-day event rate also showed no
difference between two groups (primary PTCA 7.7%, thrombolysis 11.1%, p=1.0) and
there was similar tendency in 8-month event rate (primary PTCA 19.2%, thrombolysis
14.8%, p=0.62). However, the admission duration of primary PTCA group was shorter
than that of thrombolysis (8.7 vs 12 days, p=0.03). Conclusion : Primary PTCA have
similar clinical outcome except shorter hospital admission duration when compared to
thrombolysis with routine elective coronary angiography and delayed PTCA in AMI
patients without cardiogenic shock.
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KEYWORD
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