PRIMARY CORONARY ANGIOPLASTY IN HOSPITALS WITH AND WITHOUT SURGERY BACKUP

In the Myocardial Infarction Triage and Intervention (MITI) project, a registry of acute myocardial infarction, 1,062 patients were treated for acute myocardial infarction using primary coronary angioplasty. Of those, 470 (44%) received the procedure in hospitals without coronary surgery capability on-site. These patients were compared to 592 (56%) other patients treated in hospitals with on-site surgery. Most baseli ne characteristics of patients treated by primary angioplasty were sim ilar in the two types of centers. ST segment elevation was present in 76% of patients; time from admission to angiography averaged 100 +/- 7 1 minutes (median 77 minutes). There was no difference in procedural s uccess rate nor initial and long-term mortality rates in patients trea ted by primary angioplasty in the two types of hospitals. The mortalit y rate at discharge for patients treated by primary coronary angioplas ty was 7% in both types of hospitals. In the subset of patients with S T segment elevation and no evidence of shock and no prior bypass surge ry, 30 day mortality rates were 7% and 8% (p=0.46), respectively. In a multivariable analysis of those factors influencing survival, age, a history of prior myocardial infarction, and anterior ST elevation but not the availability of on-site surgical backup, was associated with o utcome. In summary, this observational study suggests that with approp riate patient selection, trained operators, and a provision for hospit al transfer, primary coronary angioplasty can be accomplished in cente rs without on-site surgery with acceptable outcomes.