Emergency percutaneous transluminal coronary angioplasty in acute myocardial infarction: A 3 year experience

Abstract

In 151 patients experiencing acute myocardial infarction, emergency coronary angioplasty was performed as primary therapy. Overall, angioplasty was successful in 132 patients (87%); it was successful in 91 (85%) of 107 patients with a totally occluded infarct-related artery and in 41 (93%) of 44 patients with a subtotally occluded infarct-related artery. After successful angioplasty, mean residual stenosis was 29% (range 0 to 70). Eighteen patients were in cardiogenic shock (12%) including four patients receiving cardiopulmonary resuscitation during the angioplasty procedure. Hospital mortality was 9%, with 7 of 13 deaths occurring in patients presenting with cardiogenic shock or intractable ventricular arrhythmia. Hospital mortality was 5% in patients with successful angioplasty versus 37% in those with unsuccessful angioplasty (p less than 0.001). In the immediate period after angioplasty, left ventricular ejection fraction was significantly lower for patients with lesions of the left anterior descending artery (34 +/- 10%) than for patients with lesions of the left circumflex or right coronary artery (43 +/- 11%). In patients with successful angioplasty, significant improvement in left ventricular ejection fraction averaged 13 +/- 12% (p less than 0.001) for those with lesions of the left anterior descending artery and 10 +/- 12% (p less than 0.001) for those with lesions of the left circumflex or right coronary artery. Repeat coronary angiography was performed in 85 (70%) of 121 patients who had successful angioplasty and survived hospitalization without requiring bypass surgery; restenosis was found in 26 (31%), and angioplasty was repeated in 22 patients, successfully in each.(ABSTRACT TRUNCATED AT 250 WORDS)

Outcomes of Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction at Tehran Heart Center

“…The success rate of angioplasty in this study (95%) was similar to that in other series [10,11] ; however, in our study, no patient underwent emergency bypass surgery following unsuccessful PCI.…”

Timing, mode, and predictors of death after direct angioplasty for acute myocardial infarction

“…Other large series and recent randomized trials confirm this observation [7,[16][17][18],411. The absence of major intracranial bleeding after direct angioplasty with- out antecedent thrombolytic therapy is in contrast to the data from the thrombolytic trials [3-61.…”

“…Rothbaum et al [7] and Schroder et al [41] observed no cardiac rupture in patients after successful direct angioplasty for acute myocardial infarction without antecedent thrombolysis. Delayed healing and hemorrhage in the myocardium have been observed in patients who died after thrombolytic therapy but not after primary angioplasty for acute myocardial infarction [42-441, Successful direct angioplasty may limit the occurrence of hemorrhagic infarction and cardiac rupture.…”

Impact of a well-organized collaborative team approach on mortality in patients with ST-segment elevation myocardial infarction

“…Early and sustained patency of the infarct-related artery has been related to improved in-hospital and late survival (24,25), recovery of left ventricular function (24,(26)(27)(28), prevention of ventricular aneurysm formation (29), and cardiac rupture (30), and enhanced electrical stability (31). In addition, previous studies have demonstrated that only the acute restoration of TIMI grade 3 flow, present in ≈50% to 60% of vessels after fibrinolysis, is independently predictive of in-hospital survival and reduction in infarct size (26,32,33).…”