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Failed direct coronary angioplasty for acute myocardial infarction: in-hospital outcome and predictors of death.

Abstract：

OBJECTIVES:The purpose of this study was to compare the mechanisms, predictors and outcome of patients with failed direct coronary angioplasty of the infarct-related artery with those in patients with successful direct angioplasty. BACKGROUND:Direct coronary angioplasty of the infarct-related artery, without antecedent thrombolytic therapy, is an effective treatment for patients with acute myocardial infarction. Concern has been expressed over high mortality rates in patients with failed direct infarct angioplasty. METHODS:All patients treated by angioplasty were prospectively entered into a computer data base. The characteristics and outcome of all patients with failed direct angioplasty were reviewed and compared with those of patients with successful direct angioplasty. RESULTS:Direct angioplasty was successful in 705 (94%) of 750 patients and unsuccessful in 45 (6%). Patients in the failure group were more likely to be in cardiogenic shock (22% vs. 7%, p < 0.003), to have had a previous myocardial infarction (44% vs. 28%, p < 0.03) and to have three-vessel coronary artery disease (44% vs. 23%, p < 0.003). Age, gender, ejection fraction, previous bypass surgery and diabetes mellitus were similar in both groups. Only the presence of multivessel coronary artery disease (p < 0.004) and cardiogenic shock (p < 0.025) were independent predictors of failed direct angioplasty. In-hospital death (31% vs. 4.8%, p < 0.001) and the need for emergency coronary artery bypass surgery (27% vs. 0.5%, p < 0.0001) were more frequent in patients with unsuccessful than in patients with successful direct angioplasty. Patients with failed direct angioplasty and in-hospital death usually had multiple high risk characteristics, including cardiogenic shock (50%), previous myocardial infarction (43%) and multivessel coronary artery disease (93%). CONCLUSIONS:Direct coronary angioplasty is an effective method for establishing reperfusion in acute myocardial infarction. Procedural failure is infrequent, usually occurring in patients with high risk baseline characteristics.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Bedotto JB,Kahn JK,Rutherford BD,McConahay DR,Giorgi LV,Johnson WL,O'Keefe JH,Shimshak TM,Ligon RW,Hartzler GO

doi

10.1016/0735-1097(93)90178-4

subject

Has Abstract

pub_date

1993-09-01 00:00:00

pages

690-4

issue

eissn

0735-1097

issn

1558-3597

pii

0735-1097(93)90178-4

journal_volume

pub_type

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Failed direct coronary angioplasty for acute myocardial infarction: in-hospital outcome and predictors of death.