A comparison of percutaneous coronary intervention and surgical revascularization after fibrinolysis for acute myocardial infarction. Insights from the InTIME-2 trial

Abstract

Background: A substantial proportion of patients treated with fibrinolytics for acute myocardial infarction (AMI) is subsequently submitted to surgical or percutaneous revascularization procedures during the same hospitalization. However, data comparing these procedures are scarce in the literature. The purpose of this study was to analyze the outcomes of a population with AMI who, during the in-hospital phase, received fibrinolytic therapy followed by coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI). Methods: The study population included 3532 patients submitted to CABG (N = 574) or PCI (N = 2958), out of 15,114 patients studied in the InTIME-2 trial. Among patients treated with PCI there were no differences between those who received stents or isolated balloon angioplasty, so that their data were pooled for analysis. Results: CABG and PCI groups were compared regarding all-cause mortality (at 30 days and one year post-AMI) and non-fatal events (reinfarction, need of additional post-discharge revascularization and re-hospitalization for an ischemic event) within 30 days after MI. There was no significant difference in mortality rates between the groups – both unadjusted and adjusted – at 30 days and one year post-MI. The unadjusted 30-day rates of combined fatal and non-fatal events were 10.3% for the CABG group, and 15.3% for the PCI group (odds-ratio 0.64, P = 0.0017), but the adjusted odds-ratio for the combined endpoint only achieved borderline significance (P = 0.048). Conclusion: Mortality rates for CABG and PCI were similar up to one year after AMI, but CABG tends to carry a better event-free survival in the first 30 days.