Table 2.

Pros and cons of primary angioplasty^* compared with thrombolysis

Advantages

• High patency rates (> 90%) with brisk, antegrade flow

• Lower mortality

• Better residual left ventricular function

• More rapid electrocardiographic normalisation

• Less recurrent ischaemia (angina, reinfarction, exercise induced ischaemia)

• No systemic fibrinolysis, therefore bleeding problems avoided

• Improved risk stratification by angiography with identification of patients suitable for coronary artery bypass surgery

Disadvantages

• Higher procedural cost than streptokinase or alteplase (although long term costs lower)

• Can be performed only when cardiac catheterisation facilities and experienced staff available

• Recanalisation more rapid than thrombolysis only if 24 hour on-call team available

• Risks and complications of cardiac catheterisation and percutaneous intervention

• Reperfusion arrhythmias probably more common because of more rapid recanalisation

^*With or without stenting