Retrospective Comparison of a Strategy of Primary Coronary Angioplasty versus Intravenous Thrombolytic Therapy for Acute Myocardial Infarction in a Community Hospital without Cardiac Surgical Backup.

Recent studies have demonstrated the benefit of primary percutaneous coronary angioplasty (PTCA) for the emergency treatment of acute myocardial infarction. We retrospectively examined our experience in performing primary PTCA in a community hospital without in-hospital surgical backup. Only highly experienced angioplasty operators participated, and patients were immediately transferred to a tertiary care referral hospital following primary angioplasty and stabilization. A total of 102 patients received PTCA at the community hospital during the study period. Forty received PTCA for cardiogenic shock or for rescue angioplasty. The remaining 62 patients (the Primary Angioplasty Group) were compared with a matched group of patients who received thrombolytic therapy during the same time period (the Thrombolytic Therapy Group). Angioplasty was angiographically successful in 96% and TIMI-3 grade blood flow was achieved in 85% of patients who received PTCA. There were no significant differences between the two groups in terms of in-hospital complications. The duration of hospital stay was significantly less in the Primary Angioplasty Group as compared with the Thrombolytic Therapy Group (median = 4 vs. 6 days, p = 0.005), as was the duration of intensive care unit stay (median 1 vs. 2.5 days, p = 0.001). Thus, under carefully controlled conditions, primary angioplasty for acute myocardial infarction in a community hospital without in-hospital cardiac surgery is an effective and more efficient alternative to thrombolytic therapy.