BALLOON ANGIOPLASTY FOR ACUTE MYOCARDIAL- INFARCTION - RESULTS FROM THE REGISTRY OF THE NSCHAFT-LEITENDER-KARDIOLOGISCHER-KRANKENHAUSARZTE (ALKK) IN 4625 PATIENTS

Balloon angioplasty as the treatment of first choice in the setting of an acute myocardial infarction (AMI) is gaining widespread acceptance because of favourable results from specialised centres concerning hig h patency rates and low mortality. This study reports the results of a ngioplasty for AMI at large community hospitals during 1992-1995. 4625 procedures were performed at 68 centres of the Arbeitsgemeinschaft Le itender Kardiologischer Krankenhausarzte (ALKK). The age of the patien ts was 60,8 +/- 11,3 years, with 75,1% men. The infarct related artery was the left anterior descendent in 43%, the right coronary artery in 37%, the circumflex artery in 16%, a bypass graft in 2,3% and the lef t main stem in 1,4% of patients. The success rate (residual stenosis < 50%) of the intervention was 86%. There was a wide range of procedure s per centre, with a median of 40 AMI angioplasties per year and centr e. The amount of angioplasties for AMI in relation to all angioplastie s performed during this period rose from 5,2% in 1992 to 5,9% in 1995 (p = 0,01). Local complications at the puncture site occurred in 3,2%, with the need for a surgical intervention in 1,1% of patients. In 273 (5,9%) of the patients a second angioplasty was performed during the hospital stay. Aortocoronary bypass surgery was performed in 3% of the patients. Hospital mortality was 9,5% (438/4625 patients). The mortal ity rate remained constant during the years investigated (1992: 10,6%; 1993:8,6%; 1994:9,7%; 1995: 9,8%: p = ns). Higher mortality was obser ved in older patients, patients with multiple vessel disease, the left anterior descending artery or a bypass graft as infarct related arter y as well as in patients with failed reperfusion (residual stenoses > 50%). Hospitals with a case load of more than 40 angioplasties for AMI per year showed a lower mortality as compared to the others. In clini cal practice at large community hospitals results of angioplasty for A MI concerning mortality, complications and technical success rate are comparable to those of highly specialised centres. The absolute number s of angioplasties for AMI increased constantly over the years.