M. Zimarino et al., PREDICTORS OF SHORT-TERM CLINICAL AND ANGIOGRAPHIC OUTCOME AFTER CORONARY ANGIOPLASTY FOR ACUTE MYOCARDIAL-INFARCTION, Catheterization and cardiovascular diagnosis, 36(3), 1995, pp. 203-208
Coronary angioplasty is an effective method to achieve myocardial repe
rfusion in acute myocardial infarction (AMI). We reviewed our experien
ce in 132 patients (pts) who underwent percutaneous transluminal coron
ary angioplasty (PTCA) of a totally occluded infarct-related artery (I
RA) within 24 h after the onset of symptoms (mean delay 10 +/- 7 h), i
n order to identify the predictors of primary success and of major com
plications. PTCA was successfully performed in 113 patients (86%). Fai
lure without complications occurred in 12 patients (8.4%); untoward ev
ents (death and emergency CABG) occurred in seven patients (5.3%). Pts
in the failure group were more likely to have cardiogenic shock (53 v
s. 8.8%, P < .0005), longer time to reperfusion (15 +/- 6 vs, 9 +/- 6
h, P < .0005), lower ejection fraction (EF) (42 +/- 15 vs. 54 +/- 12%,
P < .0005), multivessel disease (74 vs. 43%, P < .03), and a smaller
IRA diameter (2.8 +/- 0.6 vs. 3.1 +/- 0.6 mm, P < .03). Sex, age, prev
ious bypass surgery, previous thrombolytic treatment, IRA, and infarct
location were similar in both groups. Absence of cardiogenic shock (P
< .0001), decreasing time to reperfusion (P < .005) and increasing EF
(P < .02) were independent predictors of successful PTCA. Presence of
cardiogenic shock (P < .0001) and decreasing EF (< .05) were independ
ent predictors of untoward events. Repeat angiography was performed 24
h after the procedure in the success group, Angiographic deterioratio
n (stenosis greater than or equal to 50% and/or TIMI flow grade less t
han or equal to 1) was present in 18 pts (16%), among whose 5 pts (4.4
%) had re-occlusion of the IRA, Pts with early angiographic deteriorat
ion were more likely to have a lower IRA diameter (2.8 +/- 0.5 vs, 3.1
+/- 0.6 mm, P < .02). Conclusion: Emergency PTCA is an effective meth
od for establishing reperfusion in AMI, Pts with high-risk baseline ch
aracteristics show the highest rate of untoward events, but are the mo
st likely to benefit from aggressive reperfusion therapy. (C) 1995 Wil
ey-Liss, Inc.