DIRECT PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN ACUTE MYOCARDIAL-INFARCTION - PREDICTORS OF SHORT-TERM OUTCOME AND THE IMPACT OF CORONARY STENTING

Background Direct percutaneous transluminal coronary angioplasty (PTCA ) is widely accepted in the treatment of acute myocardial infarction s ince excellent results had been reported from several small randomized trials. Less favourable results were observed in large-scale registri es. In particular, the use of stents in acute myocardial infarction ha s become common practice without documented evidence of clinical effic acy. Methods Data were analysed from a registry of all consecutive per cutaneous transluminal coronary angioplasty procedures from 62 centres in Germany, including 2331 direct percutaneous transluminal coronary angioplasty in acute myocardial infarction from July 1994 to April 199 7. Results The overall angiographic success rate of percutaneous trans luminal coronary angioplasty, defined as complete antegrade perfusion of the infarct vessel, was 87%. In-hospital mortality was 11.2%. The m ost important predictor of death was the presence of cardiogenic shock in 15% of patients, of whom 52% died. Mortality in patients without s hock was 3.9%. Failed percutaneous transluminal coronary angioplasty w as associated with a mortality of 36%. Further independent predictors of death were older age, multivessel disease, and anterior myocardial infarction. Stents were used in 4.1% of the procedures in 1994, increa sing to 53% in 1997. However, this was not accompanied by improved cli nical outcome. Mortality with coronary stenting was 9.9% vs 11.6% with out stents (ns). Conclusions Direct percutaneous transluminal coronary angioplasty is a valuable treatment strategy in acute myocardial infa rction, although the results are less exceptional than reported from s ome highly specialized centres. Failed percutaneous transluminal coron ary angioplasty seems to be harmful, thus outweighing much of the bene fit from successful procedures. Stents did not improve the clinical ou tcome significantly, despite technically successful placement in 98%. Mortality from cardiogenic shock continues to be excessively high desp ite direct PTCA.