Outcome of Primary Angioplasty as Compared with Thrombolytic Therapy for Acute Myocardial Infarction

Abstract

Background: Acute myocardial infarction (AMI), commonly known as a heart attack, occurs due to reduced or blocked blood flow in the heart's coronary artery, leading to damage to the heart muscle. Prompt medical intervention is crucial to restore blood circulation and improve patient outcomes. In recent years, advancements in treating AMI have significantly improved prognoses, with intravenous thrombolytic therapy showing a 20% to 30% reduction in early mortality rates. Two primary reperfusion therapies used are primary angioplasty and thrombolytic therapy. Primary angioplasty involves mechanically opening the blocked artery, while thrombolytic therapy uses drugs to dissolve blood clots. Aim of the Study: This study aims to compare the outcomes of these two interventions to enhance our understanding of their effectiveness and safety. Methods: This retrospective compressional study was conducted at the Department of Cardiology, Apollo Imperial Hospital, Chittagong, Bangladesh. It analyzed 480 consecutive patients who underwent Coronary Angiography (CA), with or without Percutaneous Coronary Intervention (PCI). The study spanned one year, from January 2021 to December 2022. Results: This study involved the analysis of 98 patients divided into two groups. The age distribution revealed that most patients were in the 51-60 age group, with a higher number of males (65%) than females (35%). The baseline characteristics of both groups were compared, showing no significant difference in individuals with anterior infarction. However, a highly significant difference was observed in the presence of a patent infarct-related vessel, with Group A having 89.58% and Group B having 66% of individuals with this characteristic. The study also investigated mortality and causes of death within 30 days of treatment. Group B exhibited a significantly higher proportion of cardiac-related deaths (6%) than Group A (2.08%). Additionally, heart failure was more prevalent in Group B (6%) than in Group A (2.08%). Regarding interventions, "Early Angioplasty" was administered to significantly more patients in Group B (34%) compared to Group A (4.17%). However, "Coronary-artery bypass grafting" did not show a significant difference in treatment outcomes between the group’s Late interventions ("Late Angioplasty" and "Coronary-artery") also did not yield significant differences in outcomes between the two groups. The usage of medications at the end of follow-up revealed that Warfarin and Nitrates showed statistically significant differences between the groups, while other medications did not display significant variations. Overall, this study highlighted notable differences in mortality and treatment outcomes between the two groups, particularly concerning cardiac-related deaths and the presence of a patent infarct-related vessel. Conclusion: Recent studies have shown that primary angioplasty outperforms thrombolytic therapy in managing acute myocardial infarction, improving patient outcomes and lowering mortality rates. Consequently, healthcare professionals are strongly encouraged to prioritize primary angioplasty as the first-line treatment for acute myocardial infarction, as it can enhance patient outcomes and alleviate the impact of cardiovascular diseases.