Primary angioplasty or thrombolysis? a topical parable

doi:10.1136/bmj.328.7450.1257

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ education articles:

From

Limit by

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Peter Bogaty, staff cardiologist (peter.bogaty@med.ulaval.ca)1,
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

Accepted 29 March 2004

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?

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.”