Acute myocardial infarction: patient selection for reperfusion with coronary angioplasty.
BACKGROUND
Despite the clinical advantages of mechanical reperfusion in the treatment of acute myocardial infarction, widespread use of percutaneous transluminal coronary angioplasty has been limited by a lack of human and institutional resources.


OBJECTIVE
To evaluate the feasibility of a PTCA-based reperfusion strategy for AMI patients selected according to high risk clinical criteria.


METHODS
The study group included 110 patients selected for mechanical reperfusion out of 1,080 AMI patients according to the following criteria: hemodynamic disturbance (40%), large anterior wall MI (54%), contraindication to thrombolysis (15%), previous MI (13%), re-infarction (4.5%), non-diagnostic electrocardiogram (0.9%), and unsuccessful thrombolysis (30%).


RESULTS
Cardiogenic shock was present in 23% of the cases and cardiac arrest with prolonged resuscitation in 8%. The cohort 30 day mortality rate was 15%. The 30 day mortality rate for patients without cardiogenic shock was 6.3%.


CONCLUSIONS
Selection of high risk patients who would benefit most from mechanical reperfusion appears feasible, resulting in low mortality rates when compared with those in the literature. Widespread implementation of well-defined selection criteria should promote better utilization of the limited resources available for primary PTCA.
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D012008:Recurrence; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology; D015912:Thrombolytic Therapy