Clot dissolving therapy or angioplasty in early acute heart attacks

Outcomes are comparable between primary removal of clot in heart artery with stent angioplasty and clot-dissolving drugs in patients with ST-elevation heart attacks who present early. 

Results of STREAM study

·        Best is stent angioplasty if it can be done within 1 hour of presentation to the hospital.

·        Those who present within 3 hours of chest pain and stent angioplasty cannot be done in one hour there was no difference between the two treatments (stent angioplasty of clot dissolving drugs) in the primary composite end point of major adverse cardiovascular events at 30 days. 

Comments: In most non busy cardiac centers, stent angioplasty labs needs to be informed and angiographer called for doing the procedure. This takes time. In such cases, give clot-dissolving drugs.