LATE OUTCOME AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY DURING ACUTE MYOCARDIAL-INFARCTION

Early reperfusion for acute myocardial infarction (AMI) results in imp roved ventricular function and survival. There is a dearth of data on long-term survival (> 5 years) after percutaneous transluminal coronar y angioplasty (PTCA) performed either as a primary procedure or in con junction with thrombolytic therapy. We studied 160 patients who underw ent PTCA during AMI between 1981 and 1987 either with (n = 101) or wit hout (n = 59) streptokinase therapy. Mean time to reperfusion was 4.6 hours, and patency was achieved in 134 patients (84%). Mean discharge ejection fraction was 46 +/- 14%. Coronary artery bypass grafting was performed before dismissal in 34 patients (21%), including 21 of 130 p atients (16%) with 1. or 2-vessel disease and 13 of 30 patients (43%) with 3-vessel disease (p < 0.05). Eleven patients (7%) died in the hos pital. The 149 hospital survivors were followed for a mean of 69 +/- 2 1 months (median 72). During follow-up, 22 patients (15%) died, 21 (14 %) had reinfarction, 23 (15%) underwent coronary artery bypass graftin g, and 21 (14%) underwent repeat PTCA of the infarct-related artery. O n univariate analysis, age 62 years, multivessel disease, ejection fra ction less-than-or-equal-to 40%, previous AMI, and being a nonsmoker a t the time of AMI were predictive of late mortality (p < 0.05 each var iable). On multivariate analysis, only ejection fraction less-than-or- equal-to 40% and prior AMI were predictive of late death. In patients treated with PTCA for AMI, late survival is excellent. Early surgical revascularization of high-risk patients may contribute to these encour aging results.