Editor—In their editorial on reducing mortality from myocardial infarction Townend and Doshi did not point out two advantages of primary percutaneous coronary intervention: long term benefit and better preservation of working ability, with consequent reduction of direct and indirect costs of coronary heart disease.1
One size fibrinolytic treatment with streptokinase is associated with worse long term clinical outcomes than primary percutaneous coronary intervention, especially in myocardial infarction with anterior ST segment elevation.2,3
The largest contributors to the expenditure of coronary heart disease are indirect cost of lost productivity resulting from morbidity and mortality (50.2% of the total cost of coronary heart disease in the USA in 2005) and hospital charges (28.1%).4 As shown by Le May et al, the primary percutaneous coronary intervention is cost saving compared with thrombolysis.5 However, indirect costs would also be expected to be lower, because this strategy reduced days of hospitalisation. The waiting list for percutaneous coronary intervention will shorten and the return to work rates will increase.
Competing interests: None declared.
References
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