[Primary percutaneous coronary interventions in acute myocardial infraction with ST-segment elevation. Experience in a heart catheterization unit without surgical backup].
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.
Dudek
Dariusz
D
II Klinika Kardiologii Instytutu Kardiologii, Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie. mcdudek@cyf-kr.edu.pl
Rakowski
Tomasz
T
Zmudka
Krzysztof
K
Legutko
Jacek
J
Mielecki
Waldemar
W
Bartuś
Stanisław
S
Turek
Paweł
P
Rzeszutko
Łukasz
Ł
Heba
Grzegorz
G
Chyrchel
Michał
M
Dziewierz
Artur
A
Bryniarski
Leszek
L
Dragan
Jacek
J
Królikowski
Tadeusz
T
Klecha
Artur
A
Jankowski
Piotr
P
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