PAMI trial

Stent therapy in STEMI remained intriguing because it allows for establishment of vessel patency and the ability to protect the culprit lesion. Several trials evaluated PCI versus PTCA, all showing a marked benefit in the combined endpoints of mortality and the requirement of revascularization with stenting [47-49]. The STENT PAMI trial helped shape the future of STEMI treatment. Overall mortality was not significantly different between the two groups however, the combined end point of mortality, reinfarction, stroke, or revascularization was positive at 6 months owing to a marked increase in the requirement for revascularization in the PTCA... 

Figure 1.2 Achievement of normal and full coronary recanalization (TIMI Grade 3 flow) with multiple strategies. The most complete recanaUzation results from primary angioplasty as shown in the GUSTO IIB and PAMI trials.

Stone GW, Grines CL, Browne KF, et al. Predictors of in-hospital and 6-month outcome after acute myocardial infarction in the reperfusion era The Primary Angioplasty in Myocardial Infarction (PAMI) trial. J Am Coll Cardiol 1995 25 370-377. 

Boutsen Y, Jamart J, Esselinckx W, Stoffel M, Devogelaer JP. Primary prevention of glucocorticoid-induced osteoporosis with intermittent intravenous pami-dronate a randomized trial. Calcif Tissue Int 1997 61(4) 266-71. 

Despite the results of the PAMI and Zwolle trials, great controversy persisted regarding the relative benefit of catheter-based reperfusion versus fibrinolytic therapy for acute myocardial infarction. Primary PTCA was regarded as a reasonable alternative to fibrinol)dic therapy but was not widely employed due to logistical problems and relative paucity of data to support its clinical benefit. It took a further decade of clinical research to settle this controversy. 

Figure 4.1 Rate of TIMI 3 flow in the infarct-related artery after primary angioplasty or stent implantation in the Stent-PAMI (32) and CADILLAC (34) trials.

Figure 4.2 Late mortality in randomized trials of angioplasty or stenting for acnte myocardial infarction (6-month follow-up except for Stent-PAMI = 1-year follow-up). (From Refs. 30,32-34.)...

Nunn CM, O Neill WW, Rothbaum D, et al. for the Primary Angioplasty in Myocardial Infarction I study group. Long-term outcome after primary angioplasty report from the Primary Angioplasty in Myocardial Infarction (PAMI-1) trial. J Am Coll Cardiol 1999 33 640-646. 

In the only comparable U.S. trial of such a strategy, the Air Primary Angioplasty in Myocardial Infarction (AIR PAMI) study, door-to-balloon times were 155 minutes, including 35 minutes from presentation to randomization. Unfortunately, this promising study was terminated early secondary to slow patient accrual. Point estimates favoring transfer for primary PCI over on-site fibrinolysis were seen among the 138 patients who were randomized, with major adverse cardiac events (death, reinfarction, or stroke) occurring in 8.4% of patients treated with PCI versus 13.6% of patients treated with fibrinolysis... 

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