BMJ  2004;328:1254-1256 (22 May), doi:10.1136/bmj.328.7450.1254

Education and debate

For and against

Primary angioplasty should be first line treatment for acute myocardial infarction

FOR

Royal Devon and Exeter Hospital, Exeter EX2 5DW dagobert@eurobell.co.uk

The UK government is considering establishing a national primary angioplasty service for patients with acute myocardial infarction. David Smith and Kevin Channer debate whether moving away from first line thrombolysis is appropriate or practical

The first 150 words of the full text of this article appear below.

There seems little doubt that acute ST elevation myocardial infarction is the result of coronary arterial occlusion and that myocardial necrosis can be limited by early restoration of normal antegrade blood flow. The relation between normal coronary artery blood flow and mortality after myocardial infarction is well documented. A meta-analysis of angiographic infarct trials showed normal flow was associated with a mortality of 3.7% compared with 6.6% (P = 0.0001) in patients with impaired flow and 9.2% (P = 0.0003) in patients with occluded or nearly occluded infarct related arteries.¹ This relation extends to microvascular reperfusion so that mortality after myocardial infarction can be reduced to less than 1% if normal epicardial blood flow and myocardial perfusion are restored.² The mortality benefits of restoring normal flow have been shown to extend up to 12 years.³ Early restoration of normal myocardial blood flow must therefore be the therapeutic goal of the . . . [Full text of this article]

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