Emergency percutaneous transluminal coronary angioplasty in acute myocardial infarction: A 3 year experience

In 151 patients experiencing acute myocardial infarction, emergency coronary angioplasty was performed as primary therapy. Overall, angioplasty was successful in 132 patients (87%); it was successful in 91 (85%) of 107 patients with a totally occluded infarct-related artery and in 41 (93%) of 44 patients with a subtotally occluded infarct-related artery. After successful angioplasty, mean residual stenosis was 29% (range 0 to 70). Eighteen patients were in cardiogenic shock (12%) including four patients receiving cardiopulmonary resuscitation during the angioplasty procedure. Hospital mortality was 9%, with 7 of 13 deaths occurring in patients presenting with cardiogenic shock or intractable ventricular arrhythmia. Hospital mortality was 5% in patients with successful angioplasty versus 37% in those with unsuccessful angioplasty (p < 0.001). In the immediate period after angioplasty, left ventricular ejection fraction was significantly lower for patients with lesions of the left anterior descending artery (34 ± 10%) than for patients with lesions of the left circumflex or right coronary artery (43 ± 11%). In patients with successful angioplasty, significant improvement in left ventricular ejection fraction averaged 13 ± 12% (p < 0.001) for those with lesions of the left anterior descending artery and 10 ± 12% (p < 0.001) for those with lesions of the left circumflex or right coronary artery. Repeat coronary angiography was performed in 85 (70%) of 121 patients who had successful angioplasty, and survived hospitalization without requiring bypass surgery; restenosis was found in 26 (31%), and angioplasty was repeated in 22 patients, successfully in each. Reocclusion was found in eight patients (9%), all of whom were treated medically. Posthospital cardiac mortality was 2% during an average follow-up of 20 months (range 6 to 43); all three late deaths were due to severe left ventricular dysfunction. Therefore, successful emergency coronary angioplasty for acute myocardial infarction appears to salvage ischemic myocardium and to result in a low hospital and follow-up mortality rate.