[Short-term results of rescue angioplasty in patients with acute myocardial infarction and failure of thrombolysis treatment].
The present study is aimed at describing the short-term assessment of clinical and angiographic results in patients with acute myocardial infarction treated with rescue percutaneous transluminal coronary angioplasty (RPTCA).


METHODS
We reviewed retrospectively, from January 2001 to July 2004, the interventional procedures performed in patients with coronary heart disease. From a total of 3,258 patients we selected 32 (0.98%) with acute myocardial infarction and failure of thrombolysis treatment, which were treated with RPTCA to relief the symptoms. Average age was 63 years (range 47-79), there were 24 men (75%); hypertension in 29 (90.6%); diabetes mellitus in 18 (56.3%); currently smoking 24 (75%); dyslipidemia in 11 (34.4%); unstable angina in 9 (28.1%); previous myocardial infarction in 2 (6.3%). The area related to the infarction was anterior and lateral in 14 (43.8%), anteroseptal in 6 (18.8%), postero-inferior in 5 (15.6%) with electric and hemodynamic involvement in 4 (12.5%), lateral in 1 (3.1%). Thrombolysis treatment was delivered in 3.19 hours (range 2-7 hours) with streptokinase in 19 (59.4%) and rTPA in 13 (40.6%). The evaluated serum marker was CPK-MB with the highest level of 348 +/- 240 U/L. Killip Kimball (KK) class was established as follows: KKI in 5 (15.6%), II in 16 (50%), III in 5 (15.6%), and IV in 6 (18.8%). Patients with cardiogenic shock were treated with intra-aortic balloon counter-pulsation.


RESULTS
Time between symptoms and arrival to the cath lab was 11 hours (range 6-24 hours). TIMI flow was: TIMI 0 in 16 (50%). TIMI 1 in 10 (31.2%), TIMI 2 in 6 (18.8%). The number of vessels with a significant lesion was 1.9 (range 1-4). Stents were placed in 27 (84.3%) patients. Angiographic success postangioplasty was achieved in 24 (75%); there were 9 complications (28.1%), no reflow in 7 (21.8%), coronary dissection in 1 (3.1%). Six patients died (18.7%) and 4 of them (12.5%) were in cardiogenic shock.


CONCLUSIONS
RPT-CA is a high-risk procedure, being an acceptable treatment option for patients with thrombolysis failure.
Palomo Villada
José Antonio
JA
Médico del Servicio de Hemodinamia, Hospital de Cardiología del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social.
Santiago Hernández
Jaime Alfonso
JA
González Díaz
Belinda
B
Astudillo Sandoval
Raúl
R
Flores Flores
Jesús
J
Montoya Silvestre
Armando
A
Estrada Gallegos
Joel
J
Bernal Ruiz
Enrique
E
Farell Campa
Javier
J
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D017023:Coronary Angiography; D015908:Counterpulsation / Q000379:methods; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000628:therapy; D015607:Stents; D013300:Streptokinase / Q000008:administration & dosage / Q000627:therapeutic use*; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D013300:Streptokinase; D010959:Tissue Plasminogen Activator