CLINICAL STUDIES
Primary angioplasty for the treatment of acute myocardial infarction: experience at two community hospitals without cardiac surgery
Thomas P. Wharton, Jr., MD, FACC*  ,
Nancy Sinclair McNamara, RN, BSN*,
Frank A. Fedele, MD, FACC* ,
Mark I. Jacobs, MD, FACC* ,
Alan R. Gladstone, MD* and
Erik J. Funk, MD, FACC*
* Division of Cardiology, Exeter Hospital, Exeter, New Hampshire, USA
Division of Cardiology, Portsmouth Regional Hospital, Portsmouth, New Hampshire, USA
Manuscript received July 17, 1998;
revised manuscript received November 23, 1998,
accepted December 24, 1998.
Reprint requests and correspondence: Dr. Thomas P. Wharton, Jr, The Perry Medical Services Building, Suite 206, 3 Alumni Drive, Exeter, New Hampshire 03833
twharton{at}nh.ultranet.com
OBJECTIVES
We sought to establish the safety and efficacy of primary percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction (AMI) at two community hospitals without on-site cardiac surgery.
BACKGROUND
Though randomized studies indicate that primary angioplasty in AMI may result in superior outcomes compared with fibrinolytic therapy, the performance of primary angioplasty at hospitals without cardiac surgery is debated.
METHODS
Three experienced operators performed 506 consecutive immediate coronary angiograms with primary angioplasty when appropriate in patients with suspected AMI at two community hospitals without cardiac surgery, following established rigorous program criteria.
RESULTS
Clinical high risk predictors (Killip class 3 or 4, age  75 years, anterior AMI, out-of-hospital ventricular fibrillation) and/or angiographic high risk predictors (left main or three-vessel disease or ejection fraction <45%) were present in 69.6%. Angioplasty was performed in 66.2%, with a median time from emergency department presentation to first angiogram of 94 min and a procedural success rate of 94.3%. The in-hospital mortality for the entire study population was 5.3%. Of those without initial cardiogenic shock, the in-hospital mortality was 3.0%. Of 300 patients who were discharged after primary angioplasty, only four died within the first 6 months, with 97.7% follow-up. No patient died or needed emergent aortocoronary bypass surgery because of new myocardial jeopardy caused by a complication of the cardiac catheterization or angioplasty procedure.
CONCLUSIONS
Immediate coronary angiography with primary angioplasty when appropriate in patients with AMI can be performed safely and effectively in community hospitals without on-site cardiac surgery when rigorous program criteria are established.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | ECG | = electrocardiogram, electrocardiographic | | ED | = emergency department | | IABP | = intra-aortic balloon pump | | IRA | = infarct-related artery | | TIMI | = Thrombolysis in Myocardial Infarction |
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