Primary Transluminal Coronary Angioplasty (PTCA) without Fibrinolytics for the Treatment of Myocardial Infarction: Clinical and Angiographic Results Immediately after Surgery and at the Time of Hospital Discharge in a Consecutive and Prospective Series

pp 377-386

Abstract

Background

The purpose of this report is to analize the results of primary transluminal coronary angioplasty in a consecutive group of patients suffering from acute myocardial infarction.

Methods

Between October 1991 and March 1993, 37 patients underwent angioplasty; 31 men and 6 women; mean age 61.61 ±109. They presented a ST-segment elevation at 4 or more leads: anterior wall in 23 cases (62%) and inferior wall in 14 cases (38%).In21 subjects the infarction was the first symptom of heart disease; 7 had angina of recent onset; 3, progressive angina; and 6suffered from chronic stable angina.Eight of the patients had a history of previous infarction. At the time of angioplasty 3 subjects were in cardiogenic shock, 2 presented pulmonary edema and 2 procedures-were performed under respiratory assistance.

Results

Primary success defined in terms of residual obstruction < 50% and TIMI 3 grade flow was achieved in 97% of the cases (36/37) and 86% of the subjects complied with the criteria of successful angioplasty (primary success without death, emergency CABG or reinfarction during hospitalization). There were 2 cases of subacute occlusion and 3 subjects died as a consequence of complications (8%). Excluding those patients in cardiogenic shock, the mortality rate was 3% (1/34). Previous to surgery, 83.8% of the patients presented TIMI 0-1 grade flow, while immediately after angioplasty 97% of the patients presentedTIMI 3 grade flow and the results of the tests performed before being discharged from the hospital showed that 94.6% of the subjects maintained TIMI 3 grade flow (p <0.0001). The average degree of obstruction was 97.62%; 15.27%, and 23.96% recorded before, immediately after, and at 6.5 days respectively (p <0.0001).The mean time between the onset of symptoms to the flow restoration was 5.03 ± 2.37 hours. In 25 subjects, the ejection fraction before angioplasty was compared to that 6.5 days after the procedure through the Dodge method. The average ejection fraction was 35.94 ± 11.5% pre-angioplasty and 46.5±797% after 6.5 days (p<0.003) which implies an increase of 10.66 ± 5.93 in terms of percentage. There was no statistically significant differences as regards the location of the infarction. Eighteen subjects presented an ejection fraction < 40% prior to flow restoration and 78% of these subjects evidenced an ejection fraction > 40% after 6.5 days (p = 0.003).

Conclusions

1) Angioplasty had a high primary success rate with a low residual obstruction and low mortality. 2) A high percentage of arteries presented TIMI 3 grade flow at the time of hospital discharge. 3) The ejection fraction increased significantly after successful angioplasty. 4) We believe angioplasty is another therapeutic option for patients presenting with acute myocardial infarction.