Coronary angioplasty in emergency treatment of myocardial infarction in a community-hospital setting

From July 1986 through June 1988, 135 consecutive patients with myocardial infarction, including 23 in cardiogenic shock, were treated with percutaneous transluminal coronary angioplasty in a community-hospital setting. In 109 (81%) of the cases, angioplasty was successful, resulting in brisk anterograde flow and in residual stenosis of less than 50%. The success rate was 88% (99/112) for patients not in cardiogenic shock and 43% (10/23) for those in shock. During the term of hospitalization, clinically evident total reocclusion occurred in 5 (4%) patients not in shock on presentation (2 of these experienced anterior infarction, and 3 inferior infarction); repeat angioplasty was performed successfully in all 5. No clinical reocclusion was detected in the smaller group of patients admitted in shock. Eleven patients (8%) underwent emergency coronary artery bypass grafting following the coronary angioplasty procedure: 4 for failed angioplasty in the infarct-related artery, and the other 7 for severe triple-vessel disease. Hospital mortality was 0.9% (1/112) for patients not in cardiogenic shock and 52% (12/23) for those admitted in shock, for an overall rate of 10% (13/135). Among patients whose balloon angioplasty was successful, hospital mortality was 0% for those not in shock and 30% (3/10) for those in shock. Among patients whose angioplasty failed, however, mortality was 8% (1/13) for those not in shock and 69% (9/13) for those admitted in shock.