Rescue-PTCA in acute myocardial infarction. Acute and long-term results

Background: The results from studies of coronary angioplasty after failed t hrombosis (rescue-PTCA) in acute myocardial infarction are contradictory Lo ng-term results were not presented till now. Therefore we analyzed the data from our registry of those patients whose acute and long-term results were available. Patients and methods: Data of 49 patients were analyzed who had been admitt ed for rescue-PTCA from other hospitals. Thrombolysis had to be started < 6 hours (mean 2.7 hows) from onset of symptoms. Rescue-PTCA bad robe complet ed within < 24 hours (mean 10.5 hours). 37 patients received streptokinase, seven rt-PA, three urokinase and two prourokinase. Electrocardiographic an d clinical criteria were used to define failure of thrombolysis. The data o f the acute results were from a prospective registry and the long-term resu lts came from clinical follow-up visits and a questionnaire sent to the pat ients. Results: Mean age of the patients was 48.5 years (38-78 years), 45 male, ni ne patients in cardiogenic shock (18%), infarct related artery (IRA): RCA 2 2X, LAD 21X, LCX 5X, CABG 1X, single vessel disease 27X, multiple vessel di sease 22X. Acute results: Initial IRA-TIMI flow 0 in 28 patients, 1 in twel ve patients, 2 in 9 patients; after rescue-PTCA TIMI now 1 in one patient, 2 in two patients, 3 in 46 patients (procedural success 94%). Hospital mort ality 8.2% (four patients), all in cardiogenic shock. Early reocclusion rat e 10%. Bleeding complications 14%, no fatal complications. Long-term result s: Observation period 2.5 years in 42 patients (0.5-6.5 years). Three more deaths. Total mortality 14% (7/49). Angiographic follow-up: Ejection fracti on initially 50%; 53% after months. Repeat revascularization in 43% (15/35) . Re-PTCA in 8/35, surgery in 6/35 patients, 1 X transplantation. 80% of th e patients were free from angina or heart failure. Conclusions: Rescue-PTCA in acute myocardial infarction has a high procedur al success rate with a low hospital mortality. It is the treatment of choic e for patients in cardiogenic shock. Transportation to an interventional ce nter is safe. The reintervention rate is comparably high. The long-term res ults are good.