Primary coronary angioplasty for acute myocardial infarction (the Primary Angioplasty Registry).
During a 14-month period, 6 experienced centers prospectively enrolled 271 patients into a registry in which percutaneous transluminal coronary angioplasty was the primary treatment for acute myocardial infarction. Patients age > 18 years who presented with ST-segment elevation on the 12-lead electrocardiogram were enrolled if symptom duration was < 12 hours and there was no proclivity for bleeding. An independent core angiographic laboratory processed the angiographic data. Of 271 patients giving informed consent, 245 (90%) were deemed anatomically suitable and underwent angioplasty therapy. Upon leaving the catheterization laboratory 98% of patients had achieved reperfusion; 92% had a residual visual stenosis < or = 50%. Emergency bypass surgery was required in 14 patients (5%) for either failed angioplasty (n = 3) or presumed life-threatening anatomy (n = 11). The in-hospital mortality rate was 4%, whereas the reinfarction rate was 3% and the stroke rate was 1%, with 1 intracranial hemorrhage and 2 embolic events. Bleeding requiring > or = 2 units of blood occurred in 46 patients (18%); 14 of these transfusions were related to coronary artery bypass surgery. Primary angioplasty is associated with a high reperfusion rate, low in-hospital mortality and few recurrent myocardial ischemic events. These results point to the need for a large-scale trial comparing angioplasty with thrombolytic therapy in the setting of acute myocardial infarction.
O'Neill
W W
WW
Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073.
Brodie
B R
BR
Ivanhoe
R
R
Knopf
W
W
Taylor
G
G
O'Keefe
J
J
Grines
C L
CL
Weintraub
R
R
Sickinger
B G
BG
Berdan
L G
LG
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000592:standards; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome