CONSERVATIVE MANAGEMENT OF PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION AND SPONTANEOUS ACUTE PATENCY OF THE INFARCT-RELATED ARTERY

The role of systematic emergency percutaneous transluminal coronary an gioplasty (PTCA) in patients with spontaneous reperfusion during myoca rdial infarction is debated. We retrospectively examined the inhospita l outcome of 47 consecutive patients with myocardial infarction <6 hou rs and angiographically proven spontaneous potency of the infarct arte ry managed without initial PTCA. There was one death (2.1%) and no inc idence of reinfarction. Predischarge angiography showed regression of the culprit coronary lesion to <50% stenosis in 23% of the patients, t herefore obviating the need For PTCA. However, 17% of the patients had acute recurrent ischemia, requiring emergency intervention in 10.6%. Comparison with matched patients in whom Thrombolysis in Myocardial In farction grade 3 patency was achieved by thrombolysis or by primary PT CA showed that patients with spontaneous patency tended to have smalle r infarctions, as judged from a lower peak creatine kinase level (1132 +/- 1002, 2051 +/- 1536, and 2715 +/- 2146 IU, respectively; p = 0.00 1) and a higher left ventricular election fraction (56.4%, 47.9%, and 48.7% respectively; p = 0.02). In conclusion, these patients have an e xcellent inhospital outcome, with evidence of less myocardial damage t han in patients in whom reperfusion therapy was required to achieve TI MI 3 potency. Initial conservative treatment appears safe.