LONG-TERM FOLLOW-UP AFTER DIRECT PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY FOR ACUTE MYOCARDIAL-INFARCTION

Objectives. The purpose of this study was to analyze long term follow up information over several years from consecutive, unselected patient s treated with direct percutaneous transluminal coronary angioplasty ( PTCA) for acute myocardial infarction (MI). Background. Direct PTCA is often used in patients with acute MI. Short-term results are favorabl e. However, there is less information available on long-term observati ons over several years in these patients. Methods. A total of 416 cons ecutive and unselected patients with acute MI underwent direct PTCA, S urvival of the acute infarct phase was 94.2%; the remaining 392 patien ts - the study population - were discharged and followed for 3.3 +/- 1 .4 years. Mortality as well as cardiac events and reinterventions are reported. Clinical variables assessed at the time of discharge are sub mitted to statistical analysis to detect potential risk factors. Resul ts. Total cumulative mortality in the first year was 10% for the entir e group and 6% for patients not presenting in cardiogenic shock. Morta lity after discharge was 4.6% in the first year and dropped to <4% per year thereafter. Reinterventions after discharge were required in 16% in the first year and in <4% per year in years 2 to 4. Poor left vent ricular ejection fraction (<35%), three vessel disease and advanced ag e (greater than or equal to 75 years) were long term risk factors for total mortality after direct PTCA, Conclusions. The clinical benefit o f direct PTCA for acute MI is maintained during follow up with respect to mortality, However, reinterventions for restenosis or de novo sten osis are often required (10% to 20%), Although few in number (<10%), p atients with severely impaired left ventricular function continue to h ave a poor prognosis. (C) 1998 by the American College of Cardiology.