Primary Angioplasty versus Thrombolysis for Acute Myocardial Infarction

To the Editor: In the November 4 issue, Zijlstra et al.¹ report a better long-term outcome after primary angioplasty than after thrombolysis in patients with acute myocardial infarction. Should the debate about the relative merits of angioplasty and thrombolytic therapy now be closed, as Faxon and Heger suggest in the accompanying editorial?² We do not think so, since the discussion to date has focused on in-hospital thrombolysis, and the role of prehospital thrombolysis has been underestimated.The time from the onset of symptoms to the initiation of treatment is a major determinant of the outcome after thrombolytic therapy.³ The delay . . .