Late outcome after percutaneous transluminal coronary angioplasty during acute myocardial infarction.
Early reperfusion for acute myocardial infarction (AMI) results in improved ventricular function and survival. There is a dearth of data on long-term survival (> 5 years) after percutaneous transluminal coronary angioplasty (PTCA) performed either as a primary procedure or in conjunction with thrombolytic therapy. We studied 160 patients who underwent PTCA during AMI between 1981 and 1987 either with (n = 101) or without (n = 59) streptokinase therapy. Mean time to reperfusion was 4.6 hours, and patency was achieved in 134 patients (84%). Mean discharge ejection fraction was 46 +/- 14%. Coronary artery bypass grafting was performed before dismissal in 34 patients (21%), including 21 of 130 patients (16%) with 1- or 2-vessel disease and 13 of 30 patients (43%) with 3-vessel disease (p < 0.05). Eleven patients (7%) died in the hospital. The 149 hospital survivors were followed for a mean of 69 +/- 21 months (median 72). During follow-up, 22 patients (15%) died, 21 (14%) had reinfarction, 23 (15%) underwent coronary artery bypass grafting, and 21 (14%) underwent repeat PTCA of the infarct-related artery. On univariate analysis, age > or = 62 years, multivessel disease, ejection fraction < or = 40%, previous AMI, and being a nonsmoker at the time of AMI were predictive of late mortality (p < 0.05 each variable). On multivariate analysis, only ejection fraction < or = 40% and prior AMI were predictive of late death. In patients treated with PTCA for AMI, late survival is excellent. Early surgical revascularization of high-risk patients may contribute to these encouraging results.
O'Murchu
B
B
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Gersh
B J
BJ
Reeder
G S
GS
Bailey
K R
KR
Holmes
D R
DR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D002423:Cause of Death; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009203:Myocardial Infarction / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D012008:Recurrence; D012307:Risk Factors; D013300:Streptokinase / Q000008:administration & dosage / Q000627:therapeutic use; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014654:Vascular Patency; D016277:Ventricular Function, Left / Q000502:physiology
D013300:Streptokinase