BMJ  2004;328:1257-1258 (22 May), doi:10.1136/bmj.328.7450.1257

Education and debate

Primary angioplasty or thrombolysis? a topical parable

Peter Bogaty, staff cardiologist1, James M Brophy, staff cardiologist2

1 Quebec Heart Institute, Laval University, Ste-Foy, Quebec, Canada G1V 4G5, 2 Royal Victoria Hospital, McGill University, Montreal, Canada

Correspondence to: P Bogaty peter.bogaty@med.ulaval.ca

Primary angioplasty is being touted as a revolutionary treatment that should supersede thrombolysis in modern management of acute myocardial infarction. Would our perspective be different if angioplasty had been developed first?

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

Myocardial infarction used to be a nasty scourge, with 15-25% mortality. Then came the breakthrough discoveries that thrombotic coronary occlusion caused myocardial infarction and that balloon catheters could cross the occlusion, squash the thrombus, and re-establish flow. Thus, it was possible to abort the progression of myocardial infarction and reduce mortality. Cardiologists became interventionists. Cardiac catheterisation laboratories grew like mushrooms. Balloons and hubris were inflated as many lives were saved. A gigantic industry sprang forth of catheters, sophisticated stents, and expensive adjunctive drugs. It seemed that all was now for the best "in the best of all possible worlds" and "that things in general were settled forever."

And yet there were downsides. In a substantial proportion of cases, myocardial perfusion was unsatisfactory, even when coronary artery flow seemed adequate.1 It was speculated that this could be due to distal migration of thrombus secondary to mechanical intervention. This spurred an interest . . . [Full text of this article]

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