Direct Angioplasty for Acute Myocardial Infarction in Elderly Patients Using Transradial Approach.
BACKGROUND: In acute myocardial infarction (AMI), immediate outcome seems to be better after direct coronary angioplasty (DCA) than thrombolysis. Right transradial approach (RTRA) has been currently advocated as an alternative catheterization method for coronary angioplasty, but it is an exceptional technique in the treatment of AMI. PURPOSE: The goal of this prospective study was to evaluate feasibility and safety of DCA using the RTRA in elderly patients. METHODS: All patients, 70 years or older with AMI (less than 6 hours after the onset of symptoms), were included in this study. Exclusion criteria were ischemic Allen Test, and previous thrombolytic treatment. Left heart catheterization, with selective coronary angiograms were realized in all of them, using RTRA. RESULTS: Forty six patients, (mean age 76Â+/-5, range 70-85), (31 men, 15 women), were included. Coronary catheterization using RTRA was not possible in 4 patients, (9.1%), and DCA was not necessary in 2 other patients with two distal lesions (4.5%). In the 40 remaining patients, transradial coronary angioplasty of the infarct related vessel could be successfully achieved in 40 patients, (100%) with balloon alone in 21 patients, (52.5%), or stents in 19 patients, (47.5%). Two patients with cardiogenic shock died (in hospital mortality: 4.5%). In 2 patients, recurrent angina needed new angioplasty using the same RTRA (4.5%), and in 2 other patients, asymptomatic postprocedural right radial artery occlusion was observed. Before the 24th hr, 30/40 patients (75%) could stand up with an early discharge, (7Â+/-4 days). CONCLUSION: DCA using RTRA for AMI in elderly patients can be easily realized, with a high rate of success, without any more major local complications than using the usual femoral route, allowing earlier getting up and discharge.
Delarche
N.
N
Centre Hospitalier, Pau, FranceI.
Idir
M.
M
Estrade
G.
G
Leblay
M.
M