Hospital results of salvage angioplasty with coronary stenting after failure of thrombolysis in the acute phase of myocardial infarction.

Between December 1991 and February 19999, 25 patients (56 +/- 10 years) und erwent salvage angioplasty with coronary stenting after failure of thrombol ysis (TIMI 2), rtPA (N= 18), n-PA (N= 4), K2-tu-PA (N= 2) and streptokinase (N= 1). All were treated by aspirin and 96% were given ticlopidine for one month. The culprit artery was the left anterior descending (48%), the left circumf lex (8%) or the right coronary (44%). The average ejection fraction was 41% ; 4 patients (16%) had cardiogenic shock. The stents were implanted for occ lusive coronary dissection (36%), threatening dissection (40%), partial res ult of angioplasty (20%) or of first intention (4%). In all, 31 stents were implanted (1.2 a 0.57 stent/target lesion ratio with an average length of 20.9 +/- 10.2 mm). The stents were tabular in 51% of cases. The angiographi c success rate (TIMI 3 and residual stenosis < 50%) was 96% with maximum in flation pressures of 13.7 +/- 2.5 atm and balloons with an average diameter of 3.3 +/- 0.9 mm. Intra-aortic balloon pumping was required in 7 patients (28%). The 30 day results included a mortality rate of 16% (4 patients), a recurrence of infarction in 4% : there were no repeat angioplasties, coron ary bypass surgery or blood transfusions. The predictive factors of recurre nt coronary events were : age over 60 (p= 0.04), multivessel coronary disea se (p= 0.007), cardiogenic shock (p= 0.004) and left ventricular dysfunctio n (p= 0.015). The authors conclude that cases of failure of thrombolysis are at high risk and that salvage angioplasty with coronary stenting is associated with exc ellent angiographic results. Patients with cardiogenic shock, however, have a high mortality, irrespective of coronary patency and the use of intra-ao rtic balloon pumping.