Reducing mortality in myocardial infarction: Goal should be interhospital transfer for primary angioplasty

doi:10.1136/bmj.330.7502.1271-a

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

Letter

Reducing mortality in myocardial infarction

Goal should be interhospital transfer for primary angioplasty

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

Editor—In their editorial on reducing mortality from myocardialinfarction Townend and Doshi did not point out two advantagesof primary percutaneous coronary intervention: long term benefitand better preservation of working ability, with consequentreduction of direct and indirect costs of coronary heart disease.¹

One size fibrinolytic treatment with streptokinase is associatedwith worse long term clinical outcomes than primary percutaneouscoronary intervention, especially in myocardial infarction withanterior ST segment elevation.^2
3

The largest contributors to the expenditure of coronary heartdisease are indirect cost of lost productivity resulting frommorbidity and mortality (50.2% of the total cost of coronaryheart disease in the USA in 2005) and hospital charges (28.1%).⁴As shown by Le May et al, the primary percutaneous coronaryintervention is cost saving compared with thrombolysis.⁵ However,indirect costs would also be expected to be lower, because thisstrategy reduced days of hospitalisation. The waiting list for. . . [Full text of this article]