Reducing mortality in myocardial infarction: Primary angioplasty has strong evidence base

doi:10.1136/bmj.330.7502.1271

BMJ 2005;330:1271 (28 May), doi:10.1136/bmj.330.7502.1271

Letter

Reducing mortality in myocardial infarction

Primary angioplasty has strong evidence base

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

Editor—A short ambulance ride from the tertiary cardiaccentre from where Townend and Doshi expound the virtues of prehospitalthrombolysis plus early revascularisation lies a district hospitalthat has operated a policy of primary angioplasty for more thantwo years.¹

In this hospital, which is staffed by four cardiologists (seeauthor list), more than 200 primary angioplasty procedures havebeen performed, with a 30 day mortality of 6.5%, reduced hospitallengths of stay, and a long term cost effectiveness that iscomparable to thrombolysis. Although sometimes inconvenient,cases in truly unsocial hours (midnight to 8 00 am) representonly 20% of the total primary angioplasty burden.

Few now dispute the evidence for primary angioplasty.² As yetthere are no robust data showing the superiority of prehospitalthrombolysis over primary angioplasty. CAPTIM was not completed,³and a quarter of the study population required rescue angioplastyfor failed reperfusion. Townend and Doshi . . . [Full text of this article]

Michael P Pitt, consultant cardiologist

Michael.Pitt@heartsol.wmids.nhs.uk

Gordon Murray, consultant cardiologist, James Beattie, cardiologist, Nadia El Gaylani, consultant cardiologist

Heart of England NHS Trust, Birmingham B9 5SS