Primary angioplasty applied to selected candidates may prove more beneficial than its indiscriminate use, particularly in patients with small low risk AMI. Available data support the use of primary angioplasty over fibrinolysis in high risk patients and in patients with haemodynamic impairment (class I indicationw8). Indirect data suggest that the mechanical approach is a better alternative than fibrinolysis in clinical subsets such as the elderly, patients with right ventricular involvement, patients with AMI caused by the occlusion of vein grafts, late presenters, or subjects who are ineligible for fibrinolysis. However, subgroup analysis should be considered with caution since data fragmentation reduces the statistical power and may cause type II errors. Proper randomised trials are needed if these indications are to be fully legitimised.
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