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

Editor—In their editorial on reducing mortality from myocardial infarction Townend and Doshi did not point out two advantages of primary percutaneous coronary intervention: long term benefit and better preservation of working ability, with consequent reduction of direct and indirect costs of coronary heart disease.¹

One size fibrinolytic treatment with streptokinase is associated with worse long term clinical outcomes than primary percutaneous coronary intervention, especially in myocardial infarction with anterior ST segment elevation.^{2 3}

The largest contributors to the expenditure of coronary heart disease are indirect cost of lost productivity resulting from morbidity and mortality (50.2% of the total cost of coronary heart disease in the USA in 2005) and hospital charges (28.1%).⁴ As shown by Le May et al, the primary percutaneous coronary intervention is cost saving compared with thrombolysis.⁵ However, indirect costs would also be expected to be lower, because this strategy reduced days of hospitalisation. The waiting list for percutaneous coronary intervention will shorten and the return to work rates will increase.

¹ Department of Internal Medicine, Bjelovar General Hospital, HR-43000 Bjelovar, Croatia mivanusa{at}vip.hr

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Competing interests: None declared.

References

1. Townend JN, Doshi SN. Reducing mortality in myocardial infarction. BMJ 2005;330; 856-7. (16 April.)[Free Full Text]
2. Zijlstra F, Hoorntje JCA, de Boer MJ. Reiffers S, Miedema K, Ottervanger JP, et al. Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1999;341: 1413-9.[Abstract/Free Full Text]
3. Henriques JPS, Zijlstra F, van't Hof AWJ, de Boer MJ, Dambrink JHE, Gosselink M, et al. Primary PCI versus thrombolytic therapy: long-term follow-up according to infarct location. Heart 2005. doi: 10.1136/hrt.2005.060152 (published online 14 April).[Abstract/Free Full Text]
4. American Heart Association. Heart disease and stroke statistics—2005 update. Dallas, Texas: American Heart Association, 2005.
5. Le May MR, Davies RF, Labinaz M, Sherrard H, Marquis JF, Laramee LA, et al. Hospitalization costs of primary stenting versus thrombolysis in acute myocardial infarction: cost analysis of the Canadian STAT study. Circulation 2003;108: 2624-30.[Abstract/Free Full Text]

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Relevant Article

Reducing mortality in myocardial infarction

Jonathan N Townend and Sagar N Doshi
BMJ 2005 330: 856-857. [Extract] [Full Text] [PDF]