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

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)

This article has been cited by other articles:

				S Constantinides, T S N Lo, M Been, and M F Shiu Early experience with a helical coronary thrombectomy device in patients with acute coronary thrombosis. Heart, May 1, 2002; 87(5): 455 - 460. [Abstract] [Full Text] [PDF]

				H Sasao, K Tsuchihashi, M Hase, T Nakata, K Shimamoto, and t. N.-9. investigators Does primary stenting preserve cardiac function in myocardial infarction? A case-control study Heart, November 1, 2000; 84(5): 515 - 521. [Abstract] [Full Text]

				C. Schlensak, T. Doenst, J. Kobba, and F. Beyersdorf Protection of acutely ischemic myocardium by controlled reperfusion Ann. Thorac. Surg., November 1, 1999; 68(5): 1967 - 1970. [Abstract] [Full Text] [PDF]

				F Vermeer, A J M O. Ophuis, E J v. Berg, L G Brunninkhuis, C J Werter, A G Boehmer, A H Lousberg, W R Dassen, and F W Bar Prospective randomised comparison between thrombolysis, rescue PTCA, and primary PTCA in patients with extensive myocardial infarction admitted to a hospital without PTCA facilities: a safety and feasibility study Heart, October 1, 1999; 82(4): 426 - 431. [Abstract] [Full Text] [PDF]

				G. W. Stone, B. R. Brodie, J. J. Griffin, C. Costantini, M. C. Morice, F. G. St. Goar, P. A. Overlie, J. J. Popma, J. McDonnell, D. Jones, et al. Clinical and Angiographic Follow-Up After Primary Stenting in Acute Myocardial Infarction : The Primary Angioplasty in Myocardial Infarction (PAMI) Stent Pilot Trial Circulation, March 30, 1999; 99(12): 1548 - 1554. [Abstract] [Full Text] [PDF]

				E. Garcia, J. Elizaga, N. Perez-Castellano, J. A. Serrano, J. Soriano, M. Abeytua, J. Botas, R. Rubio, E. Lopez de Sa, J. L. Lopez-Sendon, et al. Primary angioplasty versus systemic thrombolysis in anterior myocardial infarction J. Am. Coll. Cardiol., March 1, 1999; 33(3): 605 - 611. [Abstract] [Full Text] [PDF]

				S. J. Brener, L. A. Barr, J. E. B. Burchenal, S. Katz, B. S. George, A. A. Jones, E. D. Cohen, P. C. Gainey, H. J. White, H. B. Cheek, et al. Randomized, Placebo-Controlled Trial of Platelet Glycoprotein IIb/IIIa Blockade With Primary Angioplasty for Acute Myocardial Infarction Circulation, August 25, 1998; 98(8): 734 - 741. [Abstract] [Full Text] [PDF]

				R. L White Thrombolytic Therapy in Acute Myocardial Infarction Part II: 1997 Update Asian Cardiovasc Thorac Ann, March 1, 1998; 6(1): 03 - 10. [Abstract] [Full Text] [PDF]

				COMMITTEE MEMBERS, J. F. WILLIAMS Jr, M. R. BRISTOW, M. B. FOWLER, G. S. FRANCIS, A. GARSON Jr, B. J. GERSH, D. F. HAMMER, M. A. HLATKY, C. V. LEIER, et al. Guidelines for the Evaluation and Management of Heart Failure : Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Evaluation and Management of Heart Failure) Circulation, November 1, 1995; 92(9): 2764 - 2784. [Full Text]

				F. Beyersdorf Protection of evolving myocardial infarction and failed PTCA Ann. Thorac. Surg., September 1, 1995; 60(3): 833 - 838. [Abstract] [PDF]

				C. Bauters, P. Khanoyan, E. P. Mc Fadden, P. Quandalle, J.-M. Lablanche, and M. E. Bertrand Restenosis After Delayed Coronary Angioplasty of the Culprit Vessel in Patients With a Recent Myocardial Infarction Treated by Thrombolysis Circulation, March 1, 1995; 91(5): 1410 - 1418. [Abstract] [Full Text]

				J. S. Hochman, J. Boland, L. A. Sleeper, M. Porway, J. Brinker, J. Col, A. Jacobs, J. Slater, D. Miller, H. Wasserman, et al. Current Spectrum of Cardiogenic Shock and Effect of Early Revascularization on Mortality : Results of an International Registry Circulation, February 1, 1995; 91(3): 873 - 881. [Abstract] [Full Text]

				M. R. Bell, D. R. Holmes Jr, P. B. Berger, K. N. Garratt, K. R. Bailey, and B. J. Gersh The Changing In-Hospital Mortality of Women Undergoing Percutaneous Transluminal Coronary Angioplasty JAMA, April 28, 1993; 269(16): 2091 - 2095. [Abstract] [PDF]

				M. H. Eckman, J. B. Wong, D. N. Salem, and S. G. Pauker Direct Angioplasty for Acute Myocardial Infarction: A Review of Outcomes in Clinical Subsets Ann Intern Med, October 15, 1992; 117(8): 667 - 676. [Abstract] [PDF]

				R. J. Krone The Role of Risk Stratification in the Early Management of a Myocardial Infarction Ann Intern Med, February 1, 1992; 116(3): 223 - 237. [Abstract] [PDF]

				E. J. Topol, D. R. Holmes, and W. J. Rogers Coronary Angiography after Thrombolytic Therapy for Acute Myocardial Infarction Ann Intern Med, May 15, 1991; 114(10): 877 - 885. [Abstract] [PDF]

				W. W. Rowe, R. J. Simpson Jr, D. A. Tate, P. W. Willis IV, T. C. Nichols, J. W. Noneman, and L. S. Gettes Nonemergent Cardiac Catheterization and Risk-Stratified Revascularization Following Thrombolytic Therapy for Acute Myocardial Infarction: A Critical Analysis of Therapy in the Community Setting Arch Intern Med, July 1, 1989; 149(7): 1611 - 1617. [Abstract] [PDF]

				J. J. Popma and G. J. Dehmer Care of the Patient after Coronary Angioplasty Ann Intern Med, April 1, 1989; 110(7): 547 - 559. [Abstract] [PDF]

				E. J. Topol Coronary Angioplasty for Acute Myocardial Infarction Ann Intern Med, December 15, 1988; 109(12): 970 - 980. [Abstract] [PDF]

				EMERGENCY ANGIOPLASTY IS EFFECTIVE IN ACUTE MI Journal Watch (General), August 11, 1987; 1987(811): 1 - 1. [Full Text]