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EDUCATION AND DEBATE: Kevin S Channer Primary angioplasty should be first line treatment for acute myocardial infarction: AGAINST BMJ 2004; 328: 1256-1257 [Full text]

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MI treatment: It is not black and white

Vassilis Vassiliou   (8 June 2004)

MI treatment: It is not black and white 8 June 2004
Vassilis Vassiliou, Cardiology SHO Addenbrooke's Hospital, Cambridge CB2 2QQ Send response to journal: Re: MI treatment: It is not black and white	Kevin Channer (1) and David Smith (2) present strong evidence to support their cases: one for angioplasty and the other against it. Both articles are so convincing when read on their own but when placed next to each other the evidence appears conflicting. What can the average reader conclude? For primary angioplasty or against it? What seems difficult to understand is why do we have to look at the treatment of a myocardial infarct (MI) as black or white? Why do we have to conclude that ALL the patients would benefit from angioplasty (2) or that ALL the patients would benefit from thrombolysis? We know that patients presenting with anterior MI will do better with angioplasty. We also know that patients presenting with inferior or posterior MI will do extremely well with thrombolysis alone. Furthermore, we also know from the experience of our surgical colleagues that procedures done in the middle of the night have a higher mortality than the same procedures done during day time. This is most likely to apply to angioplasty as well. Why can we not simply cultivate the culture that treatment of an MI should be patient, time and infarct specific rather than a general comment that primary angioplasty (or thrombolysis) is always better? References: 1. BMJ 2004;328:1256-1257 2. BMJ 2004 328: 1254-1256 Competing interests: None declared