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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Short- and long-term mortality for patients undergoing primary angioplasty for acute myocardial infarction

Edward L. Hannan, PhD^*, Michael J. Racz, MA^*, Djavad T. Arani, MD, FACC, Thomas J. Ryan, MD, FACC, Gary Walford, MD, FACC and Ben D. McCallister, MD, FACC^||

^* State University of New York, University at Albany, Albany, New York, USA
Buffalo General Hospital, Buffalo, New York, USA
Boston University School of Medicine, Boston, Massachusetts, USA
St. Joseph’s Hospital, Syracuse, New York, USA
^|| Mid-America Heart Institute, Kansas City, Missouri, USA

Manuscript received December 30, 1999; revised manuscript received March 31, 2000, accepted June 2, 2000.

Reprint requests and correspondence: Dr. Edward L. Hannan, Department of Health Policy, Management and Behavior, School of Public Health, State University of New York, University at Albany, One University Place, Rensselaer, New York

OBJECTIVES

The goal of this study was to learn more about the risk factors and short- and long-term outcomes for primary angioplasty.

BACKGROUND

Primary angioplasty (direct angioplasty without antecedent thrombolytic therapy) has been an effective alternative to thrombolytic therapy for patients with acute myocardial infarction (AMI). However, most reported studies have been compromised by small sample sizes and short observation times.

METHODS

New York’s coronary angioplasty registry was used to identify New York patients undergoing angioplasty within 6 h of AMI between January 1, 1993 and December 31, 1996. Statistical models were used to identify significant risk factors for in-patient and long-term survival and to estimate long-term survival for all patients as well as various subsets of patients undergoing primary angioplasty.

RESULTS

The in-hospital mortality rate for all primary angioplasty patients was 5.81%. When patients in preprocedural shock (who had a mortality rate of 45%) were excluded, the in-hospital mortality rate dropped to 2.60%. Mortality rates for all primary angioplasty patients at one year, two years and three years were 9.3%, 11.3% and 12.6%, respectively. Patients treated with stent placement did not have significantly lower risk-adjusted in-patient or two-year mortality rates.

CONCLUSIONS

Primary angioplasty is a highly effective option for AMI.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CABG = coronary artery bypass graft   CAC = cardiac advisory committee   CARS = coronary angioplasty reporting system   CHF = congestive heart failure   OR = odds ratio   PTCA = percutaneous transluminal coronary angioplasty

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