Predictors of short term clinical and angiographic outcome after coronary angioplasty for acute myocardial infarction.
Coronary angioplasty is an effective method to achieve myocardial reperfusion in acute myocardial infarction (AMI). We reviewed our experience in 132 patients (pts) who underwent percutaneous transluminal coronary angioplasty (PTCA) of a totally occluded infarct-related artery (IRA) within 24 h after the onset of symptoms (mean delay 10 +/- 7 h), in order to identify the predictors of primary success and of major complications. PTCA was successfully performed in 113 patients (86%). Failure without complications occurred in 12 patients (8.4%); untoward events (death and emergency CABG) occurred in seven patients (5.3%). Pts in the failure group were more likely to have cardiogenic shock (53 vs. 8.8%, P < .0005), longer time to reperfusion (15 +/- 6 vs. 9 +/- 6 h, P < .0005), lower ejection fraction (EF) (42 +/- 16 vs. 54 +/- 12%, P < .0005), multivessel disease (74 vs. 43%, P < .03), and a smaller IRA diameter (2.8 +/- 0.6 vs. 3.1 +/- 0.6 mm, P < .03). Sex, age, previous bypass surgery, previous thrombolytic treatment, IRA, and infarct location were similar in both groups. Absence of cardiogenic shock (P < .0001), decreasing time to reperfusion (P < .005) and increasing EF (P < .02) were independent predictors of successful PTCA. Presence of cardiogenic shock (P < .0001) and decreasing EF (< .05) were independent predictors of untoward events. Repeat angiography was performed 24 h after the procedure in the success group. Angiographic deterioration (stenosis > or = 50% and/or TIMI flow grade < or = 1) was present in 18 pts (16%), among whose 5 pts (4.4%) had re-occlusion of the IRA. Pts with early angiographic deterioration were more likely to have a lower IRA diameter (2.8 +/- 0.5 vs. 3.1 +/- 0.6 mm, P < .02).


CONCLUSIONS
Emergency PTCA is an effective method for establishing reperfusion in AMI. Pts with high-risk baseline characteristics show the highest rate of untoward events, but are the most likely to benefit from aggressive reperfusion therapy.
Department of Interventional Cardiology, CMC Parly-Grand Chesnay, Le Chesnay, France.
M
M
Zimarino
T
T
Corcos
X
X
Favereau
E
E
Garcia
C
C
Tamburino
Y
Y
Guérin
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D015425:Myocardial Reperfusion; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology; D016896:Treatment Outcome