Primary Coronary Angioplasty versus Thrombolysis

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Abstract
In the Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) substudy (June 5 issue),1 although the outcomes at 30 days with primary percutaneous transluminal coronary angioplasty (PTCA) were better than those with accelerated recombinant tissue plasminogen activator (t-PA), the relative reductions in death and reinfarction with PTCA were smaller than in the Primary Angioplasty in Myocardial Infarction (PAMI) trial, the trial in Zwolle, the Netherlands, and the Mayo Clinic trial.2-4 The base-line characteristics of the patients enrolled in these trials were similar to those of the patients enrolled in GUSTO IIb,1-4 as were the outcomes in the patients treated with thrombolysis ( Figure 1 ). The use of front-loaded t-PA therefore does not explain the differences in results.

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