title: [Feasibility, indications and immediate results of direct angioplasty without thrombolysis during the acute period of myocardial infarction].
abstract: Between June 1988 and November 1991, 64 out of 200 consecutive admissions (32%) before the 6th hour of myocardial infarction underwent angioplasty of first intention. Fifty men and 14 women (average age 62 +/- 11 years) benefitted from this 24 hour emergency interventional cardiology service. The indication was formal in 22% of patients because of a contra-indication to thrombolysis (N = 40) or cardiogenic shock (N = 4); in 6%, the choice was logical because of diagnostic uncertainty (N = 12); it was a deliberate choice in 4% of cases (N = 8). Successful angioplasty was defined as reperfusion of the occluded artery without circulatory delay or > 50% residual stenosis. Arterial recanalisation was attempted in all patients (associated with intraaortic balloon pumping in 3 cases) and was successful in 59 patients (92%) within 231 +/- 100 minutes of the onset of chest pain and within 49 +/- 29 minutes of hospital admission. The outcome was uncomplicated without any other intervention in 81% of patients (48/59). Three reocclusions were observed, two of which were symptomatic and treated successfully by repeat emergency angioplasty. Six surgical revascularisations were necessary (2 emergency, 4 secondary). One major complication related to the angioplasty was observed (haemopericardium). Global hospital mortality was 9% (6/64): three of the 4 patients admitted in cardiogenic shock, 3 of the 40 high risk patients with contra-indications to thrombolytic therapy, none of the 20 patients considered to be at low risk (uncertain diagnosis and deliberate choice).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Service de cardiologie, hôpital Bichat, Paris.
authors.forename: D
authors.initials: D
authors.lastname: Himbert
authors.forename: J M
authors.initials: JM
authors.lastname: Juliard
authors.forename: P G
authors.initials: PG
authors.lastname: Steg
authors.forename: S
authors.initials: S
authors.lastname: Baleynaud
authors.forename: G
authors.initials: G
authors.lastname: Badaoui
authors.forename: D
authors.initials: D
authors.lastname: Le Guludec
authors.forename: R
authors.initials: R
authors.lastname: Gourgon
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011379:Prognosis; D012008:Recurrence
vernacular_title: Faisabilité, indications et résultats immédiats de l'angioplastie directe sans thrombolyse en phase aiguë d'infarctus du myocarde.