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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

View larger version (16K): [in a new window]   Figure 1 Incidence of clinical and angiographic predictors of high risk. Clinical high risk predictors were present in 53.7% of 506 procedures (shown in middle layer); angiographic high risk predictors were present in 49.4% (lower layer). Both clinical and angiographic high risk predictors were present in 33.5% (shown in black). Only 30.4% had neither clinical nor angiographic predictors of high risk (upper layer). *Clinical high risk-Killip class 3–4, age 75 years, anterior infarction or prehospital ventricular fibrillation. Angiographic high risk: ejection fraction <45% or left main or three-vessel disease.

View larger version (13K): [in a new window]   Figure 2 Comparison of the outcomes of primary percutaneous transluminal coronary angioplasty (PTCA) in the 231 patients in our series who had acute myocardial infarction with ST segment elevation but without cardiogenic shock with a similar population of 245 patients undergoing primary PTCA in the Primary Angioplasty Registry (25), which required ST segment elevation and excluded patients with shock. The median times from emergency department (ED) arrival to reperfusion and the rates of PTCA success, reinfarction, stroke or transient ischemic attack (TIA), and in-hospital mortality were similar in the two groups. Black bars: Exeter and Portsmouth primary PTCA patients presenting with ST elevation without shock (n = 231). White bars: Primary Angioplasty Registry PTCA patients (n = 245).