Direct Angioplasty for Myocardial Infarction: One-Year Experience in a Center with Surgical Back-up 220 Miles Away

AIMS: To report the outcome of patients undergoing angioplasty for myocardial infarction in a general hospital in a city without cardiac surgery serving an extended population of 500,000. The nearest cardiac surgical facilities are 220 miles away. METHODS AND RESULTS: Consecutive, unselected patients with myocardial infarction associated/complicated by: cardiogenic shock (n=10), a contraindication to thrombolysis (n=16), anterior site (n=27), stent or vein graft thrombosis (n=7) or failed thrombolysis (n=11) comprised the study group (n=71) who underwent angioplasty as a reperfusion strategy. In patients presenting without cardiogenic shock, the primary procedural success rate (absence of complications, TIMI 3 flow and a residual diameter stenosis <50%) was 93.4%. In those presenting in cardiogenic shock (CGS) the procedural success rate was 40%. Seven patients (6 with CGS) died prior to hospital discharge for reasons unrelated to the angioplasty procedure (6 progressive shock, one neurological sequelae because of delayed resuscitation). Four additional patients had recurrent infarctions, all were successfully treated by repeat PTCA. Two patients were transferred emergently, by air, to the regional cardiothoracic unit in a stable state in case surgery was required. In neither instance was this the result of a direct complication of angioplasty. CONCLUSIONS: Direct angioplasty for myocardial infarction may be safely performed by trained operators in centers without nearby surgical backup.