PTCA FOR ACUTE MYOCARDIAL-INFARCTION - IN -HOSPITAL RESULTS OF 785 CONSECUTIVE PATIENTS

Rapid reperfusion of the occluded coronary artery is essential for the reduction of mortality and complications of acute myocardial infarcti ons. Intravenous thrombolytic therapy using various thrombolytic subst ances has proven to be effective and easy to perform and has gained wi despread acceptance for treatment of acute myocardial infarction. Beca use of several contraindications, as well as failure to achieve patenc y of the infarcted vessel in 25-30 % of patients, severe bleeding comp lications, a time interval of 6 or more hours after suspected onset of myocardial infarction, and a high rate of recurrent ischemia, this tr eatment is currently limited to a small percentage of patients with ac ute myocardial infarction. Immediate percutaneous transluminal coronar y angioplasty (PTCA) can be applied to nearly every patient presenting with acute myocardial infarction. Therefore, we offer immediate PTCA as the primary treatment to all of our patients presenting with acute myocardial infarction. Between January 1987 and December 1991, immedia te PTCA was performed in 785 of 903 (87 %) consecutive patients (aged 23-86 years, mean 61 +/- 10). 82 % (640/785) of the patients were men. Anterior myocardial infarction was present in 372 patients (47 %), in ferior infarction in 413 patients (53 %). 245 patients (31 %) had 1 -v essel disease, 221 patients (28 %) two-vessel disease and 319 patients (41 %) had three-vessel disease. 97 patients (1 2 %) were in cardioge nic shock. In 675/785 patients (86 %) the infarct related vessel was o ccluded (TIMI less-than-or-equal-to 1). 86 % of patients had a patent infarct related vessel (TIMI greater-than-or-equal-to 2) leaving the c atheterization laboratory. The overall in-hospital mortality was 6.9% (54/785 patients), after exclusion of high-risk patients (age > 75 yea rs, cardiogenic shock, PTCA under cardiopulmonary resuscitation) morta lity decreased to 2.5 %. Recurrent ischemia necessitated immediate rep eat PTCA in 4.4 % of the patients, in 8.1 % of patients another electi ve PTCA was performed during hospitalization and 9.7 % of patients wer e sent to surgery (4.0 % on an emergency basis). 87 % of all patients presenting with acute myocardial infarction could be treated successfu lly with immediate PTCA. With respect to the severely ill group of pat ients the primary success rate is high, the rate of reocclusion is low , and the overall mortality is extremely low. From our data, it is obv ious that immediate PTCA compared to thrombolytic therapy is the super ior treatment of myocardial infarction.