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CLINICAL STUDIES: INTERVENTIONAL CARDIOLOGY

Ten-year experience with early angioplasty in 759 patients with acute myocardial infarction

Frits Bär, MD, PhD^a, Jindra Vainer, MD^a, Jeroen Stevenhagen, MSc^*, Kars Neven, MSc^*, Rob Aalbregt, MSc^*, Ton Oude Ophuis, MD, PhD, Vincent van Ommen, MD, PhD^a, Hans de Swart, MD^a, Ebo de Muinck, MD, PhD^a, Willem Dassen, PhD^a and Hein Wellens, MD, PhD, FACC^a

^a University Hospital Maastricht and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
^* Maastricht University, Maastricht, The Netherlands
Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands

Manuscript received March 23, 1999; revised manuscript received February 16, 2000, accepted March 27, 2000.

Reprint requests and correspondence: Dr. Frits Bär, Department of Cardiology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
f.baer{at}cardio.azm.nl

OBJECTIVES

How effective and safe is rescue percutaneous transluminal coronary angioplasty [PTCA] compared with primary PTCA, and is it cost effective?

BACKGROUND

In acute myocardial infarction (AMI), primary PTCA has been shown to be beneficial in terms of clinical outcome. In contrast, the value of rescue PTCA has not been established.

METHODS

In a retrospective analysis, we compared the angiographic and clinical outcomes of 317 consecutive patients who had rescue PTCA 90 min after failed thrombolysis and 442 patients treated with primary PTCA. An estimation of interventional costs was compared with the strategies of primary and rescue PTCA or with the strategy of thrombolysis with rescue PTCA, when indicated.

RESULTS

Baseline characteristics between primary and rescue PTCA were comparable for most variables. Treatment delay was longer for patients who had rescue PTCA: 240 min. versus 195 min. Coronary patency after PTCA was comparable: 90.2% for rescue PTCA and 91.4% for primary PTCA (p = 0.67, power 71.9%). In-hospital mortality rates were 4.7% and 6.6%, respectively (p = 0.37). Also, the other complications were fairly similar during the in-hospital phase and during one-year follow-up. Predictors of death were age, infarct size, localization of AMI, failed PTCA and left main stem occlusion. The estimated interventional costs during one-year follow-up were $7,377 for primary PTCA and $8,246 for rescue PTCA: difference $869 (11.7%).

CONCLUSIONS

In this retrospective analysis of 759 patients with AMI, rescue angioplasty early after failed thrombolysis seems to be as effective and safe as primary PTCA. In the present evaluation, interventional costs of primary PTCA are less than those of rescue PTCA (p = 0.0001).

Abbreviations and Acronyms   AMI = acute myocardial infarction   ECG = electrocardiographic   GUSTO = Global Use of Strategies To Open occluded arteries trial   LCx = left circumflex coronary artery   LIMI = LImburg Myocardial Infarction trial   PACT = Plasminogen activator Angioplasty Compatibility Trial   PTCA = percutaneous transluminal coronary angioplasty   TIMI = Thrombolysis In Myocardial Infarction trial

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