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

Shaifur Rahman Shohel *

Department of Clinical and Interventional Cardiology, Apollo Imperial Hospital, Chittagong, Bangladesh.

A. F. M. Arifur Rahaman

Department of Clinical and Interventional Cardiology, Apollo Imperial Hospital, Chittagong, Bangladesh.

Imtiaz Uddin Ahmed

Department of Clinical and Interventional Cardiology, Apollo Imperial Hospital, Chittagong, Bangladesh.

*Author to whom correspondence should be addressed.


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.


Keywords: Primary angioplasty, thrombolytic therapy, acute myocardial infarction

How to Cite

Shohel , Shaifur Rahman, A. F. M. Arifur Rahaman, and Imtiaz Uddin Ahmed. 2023. “Outcome of Primary Angioplasty As Compared With Thrombolytic Therapy for Acute Myocardial Infarction”. Asian Journal of Cardiology Research 6 (1):354-62. https://journalajcr.com/index.php/AJCR/article/view/180.


Download data is not yet available.


Bullet IT. Warning signs of heart attack. Indian J Clin Pract. 2019;30(4):322-7.

ISIS-2 Collaborative Group. Second international study of infarct survival. Lancet. 1988;2:349-60.

Della GI, Miocardico SN. Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet. 1986; 1:397.

Granger CB, Califf RM, Topol EJ. Thrombolytic therapy for acute myocardial infarction: A review. Drugs. 1992;44: 293-325.

Andersen HR, Nielsen TT, Rasmussen K, Thuesen L, Kelbaek H, Thayssen P, Abildgaard U, Pedersen F, Madsen JK, Grande P, Villadsen AB. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. New England Journal of Medicine. 2003; 349(8):733-42.

Bonnefoy E, Lapostolle F, Leizorovicz A, Steg G, McFadden EP, Dubien PY, Cattan S, Boullenger E, Machecourt J, Lacroute JM, Cassagnes J. Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: A randomised study. The Lancet. 2002;360(9336):825-9.

Weaver WD, Simes RJ, Betriu A, Grines CL, Zijlstra F, Garcia E, Grinfeld L, Gibbons RJ, Ribeiro EE, DeWood MA, Ribichini F. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review. Jama. 1997;278(23): 2093-8.

GUSTO Angiographic Investigators. The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction. New England Journal of Medicine. 1993; 329(22):1615-22.

Grines CL, Browne KF, Marco J, Rothbaum D, Stone GW, O'Keefe J, Overlie P, Donohue B, Chelliah N, Timmis GC, Vlietstra RE. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. New England Journal of Medicine. 1993;328(10):673-9.

Zijlstra F, de Boer MJ, Hoorntje J, Reiffers S, Reiber J, Suryapranata H. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. New England Journal of Medicine. 1993;328(10):680-4.

Gibbons RJ, Holmes DR, Reeder GS, Bailey KR, Hopfenspirger MR, Gersh BJ. Immediate angioplasty compared with the administration of a thrombolytic agent followed by conservative treatment for myocardial infarction. New England Journal of Medicine. 1993;328(10): 685-91.

Boer MD, Reiber JH, Suryapranata H, BRAND MV, Hoorntje JC, Zulstra F. Angiographic findings and catheterization laboratory events in patients with primary coronary angioplasty or streptokinase therapy for acute myocardial infarction. European heart journal. 1995;16(10): 1347-55.

Meijer A, Verheugt FW, Werter CJ, Lie KI, Van der Pol JM, Van Eenige MJ. Aspirin versus coumadin in the prevention of reocclusion and recurrent ischemia after successful thrombolysis: a prospective placebo-controlled angiographic study. Results of the APRICOT Study. Circulation. 1993;87(5):1524-30.

Meier B, Ramamurthy S. Plaque sealing by coronary angioplasty. Catheterization and cardiovascular diagnosis. 1995;36(4):295-7.

Califf RM, Harrelson-Woodlief L, Topol EJ. Left ventricular ejection fraction may not be useful as an end point of thrombolytic therapy comparative trials. Circulation. 1990;82(5):1847-53.

Norris R, White H. Therapeutic trials in coronary thrombosis should measure left ventricular function as primary end-point of treatment. The Lancet. 1988;331(8577): 104-6.

Simoons ML, Serruys PW, van den Brand M, Verheugt FW, Krauss XH, Remme WJ, Bär F, de Zwaan C, van der Laarse A, Vermeer F, Lubsen J. Early thrombolysis in acute myocardial infarction: limitation of infarct size and improved survival. Journal of the American College of Cardiology. 1986;7(4):717-28.

Simoons ML, Vos J, Tijssen JG, Vermeer F, Verheugt FW, Krauss XH, Cats VM. Long-term benefit of early thrombolytic therapy in patients with acute myocardial infarction: 5 year follow-up of a trial conducted by the Interuniversity Cardiology Institute of the Netherlands. Journal of the American College of Cardiology. 1989;14(7):1609-15.

Kloner RA. Coronary angioplasty: A treatment option for left ventricular remodeling after myocardial infarction?. Journal of the American College of Cardiology. 1992;20(2):314-6.

Morgan S, Smith H, Simpson I, Liddiard GS, Raphael H, Pickering RM, Mant D. Prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in general practice setting: cross sectional survey. Bmj. 1999;318(7180): 368-72.

Mehta RH, Eagle KA. Fortnightly review: Secondary prevention in acute myocardial infarction. Bmj. 1998;316(7134) :838-42.

Campbell NC, Thain J, Deans HG, Ritchie LD, Rawles JM. Secondary prevention in coronary heart disease: Baseline survey of provision in general practice. BMJ. 1998;316(7142):1430-4.

McCormick D, Gurwitz JH, Lessard D, Yarzebski J, Gore JM, Goldberg RJ. Use of aspirin, β-blockers, and lipid-lowering medications before recurrent acute myocardial infarction: Missed opportunities for prevention?. Archives of internal medicine. 1999;159(6): 561-7.