REPERFUSION ORIENTATED MANAGEMENT OF THE ACUTE-PHASE OF MYOCARDIAL-INFARCTION - RESULTS IN A SERIES OF 700 CONSECUTIVES PATIENTS

The principal objective of treatment of the acute phase of myocardial infarction is the obtention of TIMI 3 complete patency. Usually, only a minority of patients receives thrombolytic therapy and complete repe rfusion in unusual. Between June 1988 and April 1996, 700 consecutive patients were admitted to Bichat hospital within 6 hours of the onset of transmural myocardial infarction (81 % men; age 59 +/- 13 years). T he objective of treatment was to obtain maximal coronary patency in th e acute phase, either by thrombolysis (with systematic angiography at 90 minutes and Salvage angioplasty in case of failure), or primary ang ioplasty or conventional treatment (usually in cases of spontaneous re perfusion). The emergency angiography and angioplasty procedures were performed by a medical team on 24 hour duty. During the acute phase, 3 16 patients received intravenous thrombolysis (angiography at 90' in 3 02 patients with salvage angioplasty in 79 patients), 304 underwent pr imary angioplasty (TIMI 3 artery in 85 % of cases) and 80 underwent co nventional treatment (including 52 cases of angiographically documente d spontaneous reperfusion). Therefore, a 81 % (566/700) rate of patent TIMI 3 arteries was obtained. The hospital mortality was 8.9 %, lower in TIMI 3 arterial patency (6 %) than TIMI 2 (20 %) or TIMI 0-1 (23 % ), p < 0.001. The mortality was 4 % in patients treated by thrombolysi s. Therefore, a reperfusion strategy associating thrombolysis and/or a ngioplasty provides a high TIMI 3 patency rate in the acute phase of m yocardial infarction with a low mortality (6 %) in consecutive, unsele cted patients.