PTCA Better

Lytic Better

Fig. 10. Relative risk reduction in death (A) and death or reinfarction (B) in individual randomized trials of primary angioplasty vs lytic therapy. Reproduced with permission from ref. 51.

Fig. 11. Six-month incidence of death and death or reinfarction in patients treated with fibrinolysis or mechanical reperfusion. From the PCAT Investigators.
Fig. 12. Benefit of mechanical reperfusion over fibrinolysis in predefined subgroups (p < 0.05 for all). From the PCAT Investigators.

and 220 min, respectively. A third of the lytic patients required emergency rescue angioplasty (53).

Two other aspects of mechanical reperfusion for acute MI were examined by the PAMI II Investigators in a trial in which all suitable patients received mechanical reperfusion (54). They tested the hypotheses that early angiography identifies patients at high risk of in-hospital death based on coronary anatomy and ventricular function and that intra-aor-tic counterpulsation (IABP) may improve the patency of the infarct-related artery after primary angioplasty in patients at high risk for recurrent ischemia. One thousand and ninety nine patients were identified within 12 h of symptom onset of acute ST elevation

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