DIRECT ANGIOPLASTY FOR MYOCARDIAL-INFARCTION - ONE-YEAR EXPERIENCE INA CENTER WITH SURGICAL BACKUP 220 MILES AWAY

Aims. To report the outcome of patients undergoing angioplasty for myo cardial infarction in a general hospital in a city without cardiac sur gery serving an extended population of 500,000. The nearest cardiac su rgical facilities are 220 miles away. Methods and Results. Consecutive , unselected patients with myocardial infarction associated/complicate d by: cardiogenic shock (n=10), a contraindication to thrombolysis (n= 16), anterior site (n=27), stent or vein graft thrombosis (n=7) or fai led thrombolysis (n-11) comprised the study group (n=71) who underwent angioplasty as a reperfusion strategy. In patients presenting without cardiogenic shock, the primary procedural success rate (absence of co mplications, TIMI 3 flow and a residual diameter stenosis <50%) was 93 .4%. In those presenting in cardiogenic shock (CGS) the procedural suc cess rate was 40%. Seven patients (6 with CGS) died prior to hospital discharge for reasons unrelated to the angioplasty procedure (6 progre ssive shock, one neurological sequelae because of delayed resuscitatio n). Four additional patients had recurrent infarctions, all were succe ssfully treated by repeat: PTCA. Two patients were transferred emergen tly, by air, to the regional cardiothoracic unit in a stable state in case surgery was required. In neither instance was this the result of a direct complication of angioplasty. Conclusions. Direct angioplasty for myocardial infarction may be safely performed by trained operators in centers without nearby surgical backup.