B. Waldecker et al., IN-HOSPITAL RESULTS AND LONG-TERM FOLLOW- UP OF DIRECT PTCA IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION, Zeitschrift fur Kardiologie, 86(9), 1997, pp. 703-711
A review of the literature suggests that direct PTCA for acute myocard
ial infarction is indicated and feasible in 90-95% of unselected, cons
ecutive patients; direct PTCA is re ported to be successful in > 90% o
f procedures. This results in a hospital mortality of 3-7% for unselec
ted patients and a 4% re-infarction rate. A recent metaanalysis of dir
ect PTCA vs i.v. thrombolysis in patients with acute infarction demons
trates a lower mortality after PTCA (4.4% vs 6.5%, p = 0.02) as well a
s lower mortality/re-infarction rate (7.2% vs 11.9%, p < 0.001). Morta
lity in the Ist year afterdischarge is < 5% with about half of the fat
alities being due to cardiac causes. Patients presenting with or devel
oping cardiogenic shock in the acute infarct phase experience a 20-50%
acute mortality. Mortality rests at < 10% in these patients in the fi
rst year after discharge. In conclusion, (1) direct PTCA is feasible w
ithout additional risks in patients with acute myocardial infarction,
(2) angiographic and clinical success rates of direct PTCA are favorab
le and superior to i.v. thrombolysis in the hands of expert operators,
and (3) referal to an institution providing the option of immediate,
direct PTCA must be considered in the patient with acute infarction bu
t contraindication(s) to i.v. thrombolysis.