[Direct angioplasty without previous fibrinolytic treatment during the 1st hours following myocardial infarction].
Direct coronary angioplasty as an emergency procedure in the first hours of myocardial infarction without prior thrombolytic therapy requires a heavy infrastructure. The different results reported in the literature show a recanalisation rate of 90% with an average hospital mortality of 7%, an acceptable risk given the inclusion of patients of over 75 years of age in these series and cases of cardiogenic shock. The reocclusion rate in the hospital phase is between 10 and 15%. At medium term, the survival rates of single vessel disease are excellent but the mortality is higher in multivessel disease (78% survival at 2 years). Angioplasty performed in the first three hours after the onset of symptoms is associated with an improvement in global an regional left ventricular function in patients with anterior infarction and altered initial left ventricular function. The preliminary results of a randomised multicenter trial comparing direct angioplasty with intravenous thrombolytic therapy with rt-PA (PAMI) seem to show in favour of angioplasty with a lower rate of complications in the hospital phase. The results of this multicenter trial should provide information as to the exact role of direct angioplasty in the initial phase of infarction, a procedure reserved for well-equipped cardiological centres with highly trained invasive cardiologists.
Marco
J
J
Unité de cardiologie, clinique Pasteur, Toulouse.
Fajadet
J
J
Robert
G
G
Cassagneau
B
B
D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D016277:Ventricular Function, Left
Angioplastie directe, sans traitement fibrinolytique préalable, dans les premières heures de l'infarctus du myocarde.