TIMING AND MECHANISM OF DEATH DETERMINED CLINICALLY AFTER PRIMARY ANGIOPLASTY FOR ACUTE MYOCARDIAL-INFARCTION

We reviewed the timing and mechanism of death in 1,184 consecutive pat ients with acute myocardial infarction (AMI) treated with primary angi oplasty from 1984 to 1995. Of 98 deaths, 48 (49%) occurred early on da y 0 or 1. The mechanisms of death were pump failure in 60 patients (61 %), reinfarction in 7 patients (7.1%), left ventricular rupture in 5 p atients (5.1%), arrhythmia in 3 patients (3.1%), other cardiac causes in 5 patients (5.1%), stroke in 6 patients (6.1%), anoxic encephalopat hy in 7 patients (7.1%), and procedure-related deaths in 5 patients (5 .1%). The strongest predictors of mortality were cardiogenic shock and unsuccessful reperfusion. Our data indicate that mortality after prim ary angioplasty, like thrombolytic therapy, is highest in the early ho urs and is usually due to pump failure. In contrast to thrombolytic th erapy, the incidence of death from myocardial rupture and bleeding com plications is low. Future treatment strategies will need to focus on t he large number of patients with early death due to pump failure, espe cially patients with cardiogenic shock. (C) 1997 by Excerpta Medico, I nc.