Primary coronary angioplasty for acute myocardial infarction with contraindication to thrombolysis.

Abstract

Patients with acute myocardial infarction (AMI) and contraindication to thrombolysis have a high mortality and morbidity with conventional medical treatment. Among 226 consecutive patients hospitalized within 6 hours of the onset of Q-wave AMI, 45 (20%) had contraindications to thrombolysis. All were treated by emergent primary angioplasty. Mean age of the 45 patients was 60 +/- 11 years and 8 (18%) were > or = 70 years old; 17 (38%) had multivessel disease and 5 (11%) presented with cardiogenic shock. Successful angioplasty was achieved in 42 of the 45 patients (93%) 52 +/- 27 minutes after admission and 238 +/- 100 minutes after the onset of pain. Overall in-hospital mortality was 9% (4 of 45). Neither major bleeding nor stroke occurred. There was 1 case of early symptomatic reocclusion, treated with emergent repeat angioplasty without reinfarction. Predischarge angiography in 33 patients showed only 1 silent reocclusion (3%). Ejection fraction at discharge was 46 +/- 13%. Repeat catheterization at 6 months in 19 patients showed 4 restenoses (21%) and 4 reocclusions (21%) of the infarct-related artery. There were 3 late deaths (2 noncardiac), which gave survival rates of 87 and 85% at 1 and 3 years, respectively, and event-free survival rates of 71 and 69% including in-hospital deaths. There were no cases of late reinfarction. Consequently, in this series, primary coronary angioplasty proved safe and highly effective in rapidly restoring sustained infarct-vessel patency during AMI, and led to a greater improvement in early and late outcomes than that reported in the literature for medically treated subjects in this high-risk subset for which thrombolytic therapy is contraindicated.

• Authors: D Himbert, J M Juliard, P G Steg, G Badaoui, S Baleynaud, D Le Guludec, M C Aumont, R Gourgon
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 71 Issue 5 Pg. 377-81 (Feb 15 1993) ISSN: 0002-9149 [Print] United States
• PMID: 8430622 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Angioplasty, Balloon, Coronary
• Cardiac Catheterization
• Contraindications
• Coronary Angiography
• Emergencies
• Female
• Follow-Up Studies
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Myocardial Infarction (mortality, therapy)
• Recurrence
• Risk Factors
• Survival Rate
• Thrombolytic Therapy
• Time Factors
• Treatment Outcome