PREDICTORS OF SHORT-TERM CLINICAL AND ANGIOGRAPHIC OUTCOME AFTER CORONARY ANGIOPLASTY FOR ACUTE MYOCARDIAL-INFARCTION

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.