Primary angioplasty Vs. fibrinolysis: An overview of randomized trials and registry data

INTRODUCTION The insight that an ST-segment elevation myocardial infarction (MI) is caused by a sudden thrombotic obstruction of a coronary artery, superimposed on a ruptured atherosclerotic plaque, has opened therapeutic windows. Since the early 1980s, treatment strategies have been introduced that aim at a rapid, complete, and persistent restoration of the coronary blood circulation to avoid irreversible myocardial cell damage. These strategies are either based on a pharmacological intervention, including (combinations of) antiplatelet, antithrombin, and fibrinolytic therapy, or on a percutaneous coronary intervention (PCI), with or without stent placement. More recently, combined pharmacological-mechanical interventions have been evaluated. This review summarizes key findings from clinical trials that were undertaken since 1980 to evaluate and describe the effectiveness, safety, and outcome of these options.