Education And Debate

Primary angioplasty or thrombolysis? a topical parable

BMJ 2004; 328 doi: (Published 20 May 2004) Cite this as: BMJ 2004;328:1257
  1. Peter Bogaty, staff cardiologist (⇑,
  2. James M Brophy, staff cardiologist2
  1. 1 Quebec Heart Institute, Laval University, Ste-Foy, Quebec, Canada G1V 4G5
  2. 2 Royal Victoria Hospital, McGill University, Montreal, Canada
  1. 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.”

Creaking system

And yet …

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