A Multicenter Study for Comparison of Direct (Primary) PTCA with Thrombolytic Therapy in Unheralded Acute Myocardial Infarction; Early and Late results: STIMULUS Study Group

The rate of reperfusion with thrombolytic therapy is higher in patients with acute myocardial infaretion (AMI) and previous angina pectoris than in patients with unheralded AMI. The effectiveness of primary PTCA and thrombolytic therapy have not been compared yet in patients with unheralded AMI. In this multicenter study, we prospectively compared these two strategies in patients with unheralded AMI presenting within 6 hours after the onset of chest pain. Patients with diabetes mellitus were excluded. Seventy-three patients were enrolled and thirty-eight patients underwent direct (primary) PTCA. Time to thrombolytic therapy and PTCA were 2.4± 1. 1 and 3.0±2.2 hours after onset of chest pain, respectively. Two patients in each group died during the hospital period. Baseline characteristics of both groups were not statistically different. Coronary angiography was performed 7±3 days after the infaretion in all patients. In the direct PTCA group, ra te of TIMI III flow (88.9% vs 69.7%; p<0.005) and left venıricular ejection fraction (63±9% vs 54±11% p<0.005) were higher. Rate of reintervention during the hospital period in the thrombolytic group was statistically higher (75.8% vs 16.7%, p