Cor Vasa 2002, 43(5):220-226
Primary coronary angioplasty as a routine treatment of acute myocardial infarction with ST elevation
- Klinika kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika
Introduction:
Randomized studies in selected groups report an in-hospital mortality of 2-4% in patients with acute myocardial infarction (AMI) treated by primary transluminal coronary angioplasty (primary PTCA). The aim of our study was to determine the value of this method as a routine reperfusion strategy in the treatment of AMI with ST elevation in all admitted patients without any selection whatsoever.
Methods:
The group included 245 AMI patients (76% of men and 24% of women with a mean age of 60.4 years) treated by primary PTCA. Anterior, posterior, and lateral wall myocardial infarction was diagnosed in 45%, 40%, and 12% of cases, respectively. On admission, 4.5% of the patients were in cardiogenic shock, and 5.3% of the patients had pulmonary edema. Ischemia time on arrival was 122 minutes, and the interval from arrival to reperfusion was 38 minutes.
Results:
The angiographic success rate of primary PTCA, defined as a TIMI 3 blood flow, and post-PTCA residual stenosis < 30% (or < 10% on stent implantation) was 91.4%. Blood flow in the infarct-related was TIMI 2 in 7.8%; only in 0.8% was the procedure a technical failure (failed revascularization). Stent implantation was undertaken in 69%, GP IIb/IIIa inhibitors were used in 4%. The in-hospital mortality of the whole group was 3.7%. The risk factors for mortality were as follows: female sex (8.5% vs. 2.2%, p < 0.05), anterior wall AMI (5.5% vs. 2.2%, p < 0.05), recurrent myocardial infarction (6.0% vs. 3.1%, p < 0.05), diabetes mellitus (6.3% vs. 2.7%, p < 0.05), heart failure (mortality by Killip class = 0.5% vs. 2.7% vs. 20% vs.45.5 % for classes I vs. II vs. III vs. cardiogenic shock, p < 0.005). The lowest mortality was shown in patients in whom the procedure resulted in normal blood flow (i.e., TIMI 3) through the infarct-related artery. The long-term fate of patients was favorable (yearly mortality 5.3%, reinfarction 2.6%, subsequent revascularization 5.7%). When evaluating left ventricular function, a significant correlation was demonstrated between TIMI frame count (cTFC) and Myocardial Blush Grade (MBG) on the one hand and LVEF and enzymatically determined infarct size; in our view, these parameters are sensitive markers of tissue perfusion.
Conclusions:
Primary PTCA including routine stent implantation is an effective reperfusion strategy with a positive impact on preserving left ventricular function, low in-hospital mortality, and a favorable long-term effect, even in unselected patients.
Keywords: Acute myocardial infarction; Primary PTCA; TIMI frame count; Myocardial Blush Grade
Published: May 1, 2002 Show citation