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CLINICAL STUDIES

Long-term follow-up after direct percutaneous transluminal coronary angioplasty for acute myocardial infarction

^a Medizinische Klinik I, Zentrum Innere Medizin, Justus-Liebig University, Giessen, Germany

Manuscript received November 24, 1997; revised manuscript received April 17, 1998, accepted June 22, 1998.

Address for correspondence: Dr. Bernd Waldecker, Medizinische Klinik I Kardiologie-Angiologie, Justus-Liebig Universität, Klinikstrasse 36, 35392 Giessen, Germany
Bernd.Waldecker{at}innere.med.uni-giessen.de

Objectives. The purpose of this study was to analyze long-term follow-up information over several years from consecutive, unselected patients treated with direct percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (MI).

Background. Direct PTCA is often used in patients with acute MI. Short-term results are favorable. However, there is less information available on long-term observations over several years in these patients.

Methods. A total of 416 consecutive and unselected patients with acute MI underwent direct PTCA. Survival of the acute infarct phase was 94.2%; the remaining 392 patients—the study population—were discharged and followed for 3.3 ± 1.4 years. Mortality as well as cardiac events and reinterventions are reported. Clinical variables assessed at the time of discharge are submitted to statistical analysis to detect potential risk factors.

Results. Total cumulative mortality in the first year was 10% for the entire group and 6% for patients not presenting in cardiogenic shock. Mortality after discharge was 4.6% in the first year and dropped to <4% per year thereafter. Reinterventions after discharge were required in 16% in the first year and in <4% per year in years 2 to 4. Poor left ventricular ejection fraction (<35%), three-vessel disease and advanced age (75 years) were long-term risk factors for total mortality after direct PTCA.

Conclusions. The clinical benefit of direct PTCA for acute MI is maintained during follow-up with respect to mortality. However, reinterventions for restenosis or de novo stenosis are often required (10% to 20%). Although few in number (<10%), patients with severely impaired left ventricular function continue to have a poor prognosis.

Abbreviations and Acronyms   LV = left ventricular   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   TIMI = Thrombolysis In Myocardial Infarction trial

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