Primary PTCA in a Rural Hospital

The results of primary percutaneous transluminal coronary angioplasty (PTCA) to treat patients with acute myocardial infarction in a rural hospital were reviewed. Thirty-five patients presenting with acute myocardial infarction, including 40% considered high risk, were treated using the strategy of primary angioplasty. Following cardiac catheterization, two patients were found to have anatomy deemed unsuitable for primary angioplasty and subsequently underwent urgent coronary artery bypass graft (CABG) surgery. Thirty-three patients underwent primary angioplasty with a procedural success rate of 94%. Procedural success was defined as reduction of the infarct arteries stenosis to less then 50% and the establishment of TIMI-III flow. Six percent of these patients required urgent CABG surgery because of unsuccessful angioplasty. In-hospital cardiac mortality was 3%. Six month follow-up was achieved for all patients. There were no cardiac deaths following hospital discharge. Recurrent ischemia occurred in 17% of the patients. Favorable in-hospital and late results were achieved. This review indicates that the strategy of primary angioplasty to treat myocardial infarction may be successfully applied in a rural setting.