Medical Reading

Primary Angioplasty May Be More Effective Than Thrombolysis In Very Elderly Patients With AMI: Results From The TRIANA Trial

July 29, 2017

Primary angioplasty is superior to thrombolysis in the treatment of very old patients with acute myocardial infarction (AMI), according to results from the TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos*) study, a randomised trial sponsored by the Spanish Society of Cardiology.**

The trial was designed to compare the two principal available treatments to open blocked coronary arteries in AMI patients: immediate primary PCI with angioplasty, and thrombolysis with clot-dissolving drugs. The trial was performed in 226 patients all aged 75 years or older and all with AMIs of less than six hours' evolution. They were recruited in 23 Spanish hospitals between 2005 and 2007.

The study, which was closed prematurely because of slow patient recruitment, found no differences between the two groups in its primary endpoint - the incidence of death, reinfarction or disabling stroke at 30 days (25.4% in the thrombolysis group and 18.9% in the primary angioplasty group, p=0.21). Despite the higher-than-anticipated rate of events in both arms, the study became underpowered to detect such differences because of its reduced recruitment. However, in a pre-specified secondary endpoint there was a significantly lower need of new catheterisation for recurrent cardiac ischemia in the primary angioplasty arm (0.8% versus 9.7%, p