CLINICAL STUDY: MYOCARDIAL INFARCTION
Primary angioplasty reduces the risk of left ventricular free wall rupture compared with thrombolysis in patients with acute myocardial infarction
Raúl Moreno, MD, FESC* ,*,
José López-Sendón, MD, FESC, FACC*,
Eulogio García, MD, FESC,
Leopoldo P.érez de Isla, MD,
Esteban L.ópez de Sá, MD, FESC*,
Ana Ortega, MD*,
Mar Moreno, MD ,
Rafael Rubio, MD*,
Javier Soriano, MD,
Manuel Abeytua, MD and
Miguel-Angel García-Fernández, MD
* Coronary Care Unit, Hospital Gregorio Marãón, Madrid, Spain
Division of Interventional Cardiology, Hospital Gregorio Marãón, Madrid, Spain
Laboratory of Echocardiography, Hospital Gregorio Marãón, Madrid, Spain
Manuscript received October 16, 2000;
revised manuscript received November 7, 2001,
accepted November 29, 2001.
* Reprint requests and correspondence: Raúl Moreno, MD, FESC, Instituto Cardiovascular, University Hospital Clínico San Carlos, Martin Lagos, s/n, 28040 Madrid, Spain.
raulmorenog{at}terra.es
OBJECTIVES: This study aimed to evaluate the effect of primary angioplasty (PA) over the risk of free wall rupture (FWR) in reperfused acute myocardial infarction (AMI).
BACKGROUND: It has been suggested that PA reduces the risk of FWR compared with thrombolysis. However, few studies have evaluated this issue, and there are no data demonstrating this hypothesis.
METHODS: A total of 1,375 patients with AMI treated with PA (n = 762, 55.4%) or thrombolysis (n = 613, 44.6%) within 12 h after symptoms onset were included. The diagnosis of FWR was made either in the presence of sudden death due to electromechanical dissociation with large pericardial effusion on an echocardiogram or when demonstrated post mortem or at surgery. A multivariable analysis was performed including type of reperfusion strategy.
RESULTS: The overall incidence of FWR was 2.5% (n = 34): 1.8% and 3.3% in patients treated with PA and with thrombolysis, respectively (p = 0.686). The following characteristics were associated with a higher rate of FWR in the univariable analysis: age >70 (5.2% vs. 1.2%, p < 0.001), female gender (5.1% vs. 1.8%, p = 0.006), anterior location (3.3% vs. 1.4%, p = 0.020) and treatment >2 h after symptoms onset (3.6% vs. 1.7%, p = 0.043). In the multivariable analysis, age >70 (odds ratio [OR]: 4.12, 95% confidence interval [CI]: 2.04 to 8.62, p < 0.001) and anterior location (OR: 2.91, 95% CI: 1.36 to 6.63, p = 0.008) were independent risk factors of FWR, whereas treatment with PA was an independent protective factor (OR: 0.46, 95% CI: 0.22 to 0.96, p = 0.0371).
CONCLUSIONS: In patients with AMI, PA reduces the risk of FWR in comparison with thrombolysis.
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Abbreviations and Acronyms
| | CADILLAC | | AMI | | acute myocardial infarction | | CADILLAC | | Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications | | CI | | confidence interval | | FWR | | free wall rupture | | GUSTO | | Global Use of Strategies to Open Occluded Coronary Arteries | | INTIME | | Intravenous nPA for Treatment of Infarcting Myocardium Early | | OR | | odds ratio | | PA | | primary angioplasty | | PAMI | | Primary Angioplasty in Myocardial Infarction | | RR | | risk ratio |
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