title: [Acute myocardial infarction: immediate coronary angioplasty for failure or contra-indications of thrombolytic therapy. Apropos of a series of 100 cases].
abstract: One hundred patients admitted to a centre of interventional cardiology with acute myocardial infarction of less than 6 hours, underwent coronary angioplasty of first intention because of contra-indications to thrombolytic therapy (n = 20) or after thrombolytic therapy with streptokinase (n = 54), acylenzymes (n = 12) or tissue type plasminogen activator (n = 14). The indication of angioplasty were those of the TIMI (Thrombolysis in Myocardial Infarction) classification (occluded artery, TIMI grade 0) (n = 60) (suboccluded artery, TIMI grade 1) (n = 40). The criterion of success of angioplasty was an increase greater than 1 of TIMI grade. Reperfusion of the coronary artery was obtained by angioplasty in 95% of failures of thrombolysis and in 90% of patients with contra-indications to thrombolytic therapy. The early reocclusion rate at D1 was 2%. Repeat angioplasty at D1 was successful in both these cases and the arteries were still patent at D21. The reocclusion rate at the third week in 75 patients who underwent control coronary angiography was 5.3%. In patients with arterial occlusion, immediate angioplasty attained two objectives in the same procedure: a high rate of emergency myocardial reperfusion and a low rate of reocclusion. The average left ventricular ejection fraction (all arteries) significantly improved (+9.2% in absolute values) when the artery remained patent (p less than 0.001), especially when the initial ejection fraction was low. In the patients who had occluded arteries at control angiography at 3 weeks, the ejection fraction decreased (-4% in absolute values) (NS). The following complications were observed: 4 coronary artery dissections and haematomas at the site of femoral puncture in patients who had received thrombolytic therapy (10 drained surgically). The hospital mortality was 3% and global mortality after an average follow-up period of 19.6 months was 5%. Coronary angioplasty in acute myocardial infarction carries a low risk and seems to be beneficial in patients with contra-indications to or failure of thrombolysis.
authors.affiliation: Service de cardiologie, hôpital de Hautepierre, CHU de Strasbourg.
authors.forename: J M
authors.initials: JM
authors.lastname: Mossard
authors.forename: R
authors.initials: R
authors.lastname: Arbogast
authors.forename: S
authors.initials: S
authors.lastname: Roman
authors.forename: J
authors.initials: J
authors.lastname: Baruthio
authors.forename: P
authors.initials: P
authors.lastname: Germain
authors.forename: G
authors.initials: G
authors.lastname: Roul
authors.forename: C
authors.initials: C
authors.lastname: Kraenner
authors.forename: P
authors.initials: P
authors.lastname: Bareiss
authors.forename: A
authors.initials: A
authors.lastname: Sacrez
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D013300:Streptokinase / Q000627:therapeutic use; D013318:Stroke Volume; D015996:Survival Rate; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016277:Ventricular Function, Left
chemical_list: D013300:Streptokinase; D010959:Tissue Plasminogen Activator
vernacular_title: Infarctus myocardique aigu: angioplastie coronaire immédiate en cas d'échec ou de contre-indication  la thrombolyse. A propos d'une série de 100 cas.