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[Results of coronary stenting in acute myocardial infarction]
Insights
Coronary angioplasty with stent placement in acute myocardial infarction shows high success rates. Mortality is concentrated in patients with severe heart failure, indicating procedural risks.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Acute Myocardial Infarction Management
Context:
- Acute myocardial infarction (AMI) necessitates prompt and effective revascularization strategies.
- Coronary angioplasty and stent placement have become a cornerstone in AMI treatment.
- Understanding the outcomes of these interventions is crucial for clinical decision-making.
Purpose:
- To evaluate the angiographic success and in-hospital clinical outcomes of AMI patients treated with coronary angioplasty and stent placement.
- To identify factors influencing mortality and morbidity in this patient cohort.
Summary:
- A study of 268 acute myocardial infarction patients treated with coronary angioplasty and stenting demonstrated a 96% angiographic success rate.
- Significant improvements in lumen diameter and stenosis reduction were observed post-procedure.
- In-hospital mortality was 15.3%, primarily concentrated in patients with higher Killip heart failure classes (II-IV).
- Rates of nonfatal reinfarction, recurrent ischemia, stent thrombosis, and target vessel revascularization were 2.6%, 9%, 3.0%, and 4.5%, respectively.
Impact:
- Coronary stenting in AMI offers high technical success and favorable in-hospital outcomes.
- The procedure's safety is strongly linked to the patient's initial cardiac function, with higher-risk patients experiencing greater mortality.
- Findings support the continued use of stenting in AMI while emphasizing risk stratification for improved patient management.
Objective:
To describe the angiographic results and the in-hospital clinical outcome of patients with an acute phase of myocardial infarction treated with coronary angioplasty and stent placement.
Methods:
268 patients with myocardial infarction were treated with angioplasty and coronary stenting within in our center 12 hours after the onset of symptoms from January in 1992 to March 1998. 366 stents were placed (1.4 +/- 0.7 per patient), 35% being Palmaz-Schatz, 26% Wiktor, 21% Multi-Link and 18% others. Stenting was elective in 171 patients (64%), and the majority of patients (91%) were treated with aspirin plus ticlopidine.
Results:
A successful angiographic result was achieved in 258 patients (96%). Minimum lumen diameter was increased from 0.2 +/- 0.3 to 2.7 +/- 0.7 mm (p < 0.001), and stenosis decreased from 94 +/- 8% to 13 +/- 11% (p < 0.001). Mortality was 15.3% (3.2%, 24.4% and 67.7% in patients in Killip class I, II-III and IV, respectively). Nonfatal reinfarction and recurrent ischemia rates were 2.6% and 9%, respectively. Stent thrombosis occurred in 8 patients (3.0%), and new target vessel revascularization was needed in 12 (4.5%).
Conclusions:
Stent placement in acute myocardial infarction is associated with high angiographic success rate, as well as a good in-hospital outcome. Mortality is localized, especially in patients with cardiac failure at the beginning of the procedure.