title: [Primary percutaneous coronary interventions in acute myocardial infraction with ST-segment elevation. Experience in a heart catheterization unit without surgical backup].
abstract: BACKGROUND
  Primary percutaneous coronary intervention (PCI) in patients (pts) with ST-segment elevation myocardial infarction is regarded as treatment superior to thrombolysis. Coronary stents and GP IIb/IIIa receptor inhibitors improved safety and clinical outcome of interventional procedures. Safety of primary PCI procedure in catheterisation laboratories which do not have on-site surgical backup is still under evaluation.
  
  
  METHODS
  In a cohort of 249 consecutive patients we analysed short and long-term clinical outcome of primary PCI performed in catheterisation laboratory which is located several kilometres from a cardiac surgery department, with an effective transfer time < 30 minutes.
  
  
  RESULTS
  Coronary stents were implanted in 43% pts. GP IIb/IIIa receptor inhibitors were used in 54.2% pts. Cardiogenic shock on admission was diagnosed in 7.2% pts. Intra-aortic balloon counterpulsation usage was necessary in 6.4% pts. In-hospital mortality was 6% (3.5% in non-shock pts). In two pts (0.8%) during hospitalization repeat PCI was performed--in one case due to reinfarction. No urgent cardiosurgery intervention was necessary. Mortality and myocardial infarction rate after hospital discharge during 6 month follow up was 2.4% and 2.8% respectively. In 4% pts repeated PCI was performed due to restensosis. Cumulative event free survival was 84%.
  
  
  CONCLUSIONS
  Primary PCI procedure for acute myocardial infarction seems to be feasible and safe in catheterisation laboratories without on-site surgical backup provided usage of stents, GPIIb/IIIa receptor inhibitors and intraaortic balloon counterpulsation and cooperation with a nearby cardiosurgery department with short transfer time.
authors.affiliation: II Klinika Kardiologii Instytutu Kardiologii, Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie. mcdudek@cyf-kr.edu.pl
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Zmudka
authors.forename: Jacek
authors.initials: J
authors.lastname: Legutko
authors.forename: Waldemar
authors.initials: W
authors.lastname: Mielecki
authors.forename: Stanisław
authors.initials: S
authors.lastname: Bartuś
authors.forename: Paweł
authors.initials: P
authors.lastname: Turek
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Rzeszutko
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Heba
authors.forename: Michał
authors.initials: M
authors.lastname: Chyrchel
authors.forename: Artur
authors.initials: A
authors.lastname: Dziewierz
authors.forename: Leszek
authors.initials: L
authors.lastname: Bryniarski
authors.forename: Jacek
authors.initials: J
authors.lastname: Dragan
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Królikowski
authors.forename: Artur
authors.initials: A
authors.lastname: Klecha
authors.forename: Piotr
authors.initials: P
authors.lastname: Jankowski
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome