IN-HOSPITAL RESULTS AND LONG-TERM FOLLOW- UP OF DIRECT PTCA IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION

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.