Relative safety and complication profiles of thrombolysis and primary angioplasty in acute myocardial infarction

Abstract

Summary The safety profile of thrombolytic therapy has been evaluated by several large-scale clinical trials; data on percutaneous coronary angioplasty (PTCA) complications in the context of acute myocardial infarction is more limited. The major life-threatening complication of thrombolytic therapy is cerebral haemorrhage, with an overall incidence of 0.7–1%, but with higher rates in the elderly, hypertensives or patients on anticoagulant therapy, or patients with a previous stroke. Non-life-threatening bleeds occur in 4–20% depending on definition and on whether or not invasive vascular procedures are involved. Allergic reactions occur in 5–7% but are seldom severe. There is a small but significant increase in the risk of cardiac rupture or ventricular septal defect. PTCA-related complications can be divided into cardiac and non-cardiac. Cardiac complications include arrhythmias, coronary dissection and abrupt coronary closure. However, since the starting point in primary PTCA is usually a completely closed vessel, the incremental damage is small. Thrombus displacement to another coronary artery, or left main or proximal right coronary dissection are serious but rare (