Clinical InvestigationAcute Ischemic Heart DiseaseHigh-risk patients with ST-elevation myocardial infarction derive greatest absolute benefit from primary percutaneous coronary intervention: Results from the Primary Coronary Angioplasty Trialist versus Thrombolysis (PCAT)-2 Collaboration
Section snippets
Methods
Details on the applied methodology of the pooled analysis have been published elsewhere.4 For the purpose of this study, we will briefly describe the trial selection and data collection process, the end point definitions, and the applied methods of data analysis.
Patients
This pooled analysis included 6,763 patients from 22 trials in which patients were randomized to fibrinolysis (n = 3,452) or PPCI (n = 3,451). Overall, 446 patients (6.6%) reached the primary end point of all-cause mortality within 30 days of randomization. There were clinically relevant differences in sex, age, history of MI, diabetes, infarct location, time to randomization, and hemodynamic status at presentation, between patients who died within 30 days and between those who survived (Table I
Discussion
In this analysis of the pooled data of 22 randomized trials, we demonstrated that the relative mortality reduction by PPCI compared with fibrinolysis was not modified by the patient's estimated mortality risk. A consistent 37% relative risk reduction by PPCI was seen across the entire spectrum of estimated risk. In contrast, and as a consequence of the consistent relative risk reduction, absolute mortality reduction was strongly associated with the patient's baseline mortality risk. Patients
Conclusion
Primary percutaneous coronary intervention is consistently associated with a strong relative reduction in 30-day mortality, irrespective of patient baseline risk, and should therefore be considered as the first choice reperfusion strategy whenever feasible. If access to PCI is longer than 2 hours, fibrinolysis remains a legitimate option, especially for patients with a low-risk score due to the small absolute risk difference between both treatment modalities in this patient group. Therefore, in
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Alvaro Avezum, MD, PhD served as guest editor for this article.