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Direct percutaneous transluminal coronary angioplasty in acute myocardial infarction. Predictors of short-term outcome and the impact of coronary stenting |
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| Authors: | Vogt, A. Niederer, W. Pfafferott, C. Engel, H.-J. Heinrich, K.W. Merx, W. Jehle, J. Neuhaus, K.-L. on behalf of the study group of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausarzte, |
| Affiliation: | a Medizinische Klinik II, Städtische Kliniken gGmbH, Kassel, Germany b Krankenhaus der Barmherzigen Brüder, Regensburg, Germany c Zweckverband-Krankenhaus, Ingolstadt, Germany d Zentralkrankenhaus Links der Weser, Bremen, Germany e Herzzentrum, Duisburg, Germany f Städtische Kliniken, Neuss, Germany g Elisabeth-Krankenhaus GmbH, Straubing, Germany |
| Abstract: | Background Direct percutaneous transluminal coronary angioplasty (PTCA)is widely accepted in the treatment of acute myocardial infarctionsince excellent results had been reported from several smallrandomized trials. Less favourable results were observed inlarge-scale registries. In particular, the use of stents inacute myocardial infarction has become common practice withoutdocumented evidence of clinical efficacy. Methods Data were analysed from a registry of all consecutive percutaneoustransluminal coronary angioplasty procedures from 62centresin Germany, including 2331 direct percutaneous transluminalcoronary angioplasty in acute myocardial infarction from July1994 to April 1997. Results The overall angiographic success rate of percutaneous transluminalcoronary angioplasty, defined as complete antegrade perfusionof the infarct vessel, was 87%. In-hospital mortality was 11·2%.The most important predictor of death was the presence of cardiogenicshock in 15% of patients, of whom 52% died. Mortality in patientswithout shock was 3·9%. Failed percutaneous transluminalcoronary angioplasty was associated with a mortality of 36%.Further independent predictors of death were older age, multivesseldisease, and anterior myocardial infarction. Stents were usedin 4·1% of the procedures in 1994, increasing to 53%in 1997. However, this was not accompanied by improved clinicaloutcome. Mortality with coronary stenting was 9·9% vs11·6% without stents (ns). Conclusions Direct percutaneous transluminal coronary angioplasty is a valuabletreatment strategy in acute myocardial infarction, althoughthe results are less exceptional than reported from some highlyspecialized centres. Failed percutaneous transluminal coronaryangioplasty seems to be harmful, thus outweighing much of thebenefit from successful procedures. Stents did not improve theclinical outcome significantly, despite technically successfulplacement in 98%. Mortality from cardiogenic shock continuesto be excessively high despite direct PTCA. |
| Keywords: | acute myocardial infarction percutaneous transluminal angioplasty mortality reperfusion cardiogenic shock coronary stenting |
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