PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOP LASTY IN THE PRIMARY-TREATMENT OF ACUTE MYOCARDIAL-INFARCTION

Basic problem and objective: Percutaneous transluminal coronary angiop lasty (PTCA) is being increasingly considered as an alternative to thr ombolytic treatment of acute myocardial infarction. Studies performed so far, some on selected groups of patients, have produced high initia l results of success. This prospective study was undertaken to determi ned primary success, complications and recurrence after primary PTCA i n acute myocardial infarction (AMI). Patients and methods: Primary tre atment in the form of immediate PTCA of the infarct vessel was underta ken in 111 patients (84 men, 27 women; mean age 58.6 +/- 10.3 years) w ith AMI. PTCA was judged successful if the infarct vessel had been reo pened to perfusion grade 3 and reststenosis was < 50%. No thrombolytic treatment was given, but heparin infusions were given during and for 24-48 hours after the procedure. 13 patients (11.7%) were in cardiogen ic shock or required cardiopulmonary resuscitation for infarct-related arrhythmia. Results: The primary success rate of PTCA for the whole g roup was 91% (101 of 111 patients), but only 77% (ten of 13) among pat ients in cardiogenic shock and (or) after resuscitation. Acute re-occl usion (0-6 days after PTCA) occurred in seven patients. Eight patients (7.2%) died during the hospital phase (0-4 weeks), seven of whom had been in shock or required resuscitation (death rate 54%). The overall complication rate of the intervention was 6.3%. No emergency aortocoro nary bypass was necessary. Repeat coronary angiography was performed i n 71 of the 101 successfully treated patients 6 or 12 weeks after the PTCA. Re-occlusion was demonstrated in four (5.6%), a re-stenosis of m ore than 50% in 25% of patients. Mean left ventricular ejection fracti on, obtained by planimetry from the levocardiogram was 58.6 +/- 9.3%. Conclusion: PTCA, performed immediately after acute myocardial infarct ion is an effective therapeutic measure with a high primary success ra te.