Related Experiment Videos
Short and intermediate clinical outcome after late coronary stenting in myocardial infarction
P Uerojanaungkul1, C Piamsomboon, C Roongsritong
1Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand.
Insights
Late coronary stenting after acute myocardial infarction (AMI) is feasible and safe, showing improved heart function and clinical outcomes. This procedure offers a favorable intermediate prognosis for patients with AMI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- The open artery theory suggests late reperfusion improves outcomes in acute myocardial infarction (AMI).
- Coronary angioplasty with stenting is a primary method for reperfusion in AMI.
- Limited data exists on the intermediate outcomes of late angioplasty with stenting.
Purpose of the Study:
- To evaluate the feasibility and intermediate clinical outcomes of late coronary stenting in patients with AMI.
- To assess changes in left ventricular ejection fraction (LVEF) following the procedure.
Main Methods:
- A prospective study involving 44 patients with AMI who underwent late coronary stenting between June 1998 and August 1999.
- Echocardiography was performed pre-procedure and at 6-month follow-up.
- Data collected included procedural success, in-hospital events, and intermediate clinical outcomes.
Main Results:
- Coronary stenting was successful in all patients, significantly reducing diameter stenosis.
- In-hospital mortality was 2.27% due to sudden cardiac death.
- At a mean follow-up of 11.4 months, there was 1 myocardial infarction (2.3%), 2 cases of congestive heart failure (4.65%), and no cardiac deaths. Left ventricular ejection fraction (LVEF) significantly improved (47.75% to 54.89%, p < 0.001).
Conclusions:
- Late coronary stenting in the infarct-related artery of AMI patients is a feasible procedure with a low complication rate.
- The study demonstrated improved LVEF and favorable intermediate clinical outcomes, supporting the open artery theory.
Background:
The open artery theory has been proposed that late reperfusion of an occluded coronary artery favorably affects clinical outcome. Myocardial reperfusion can be achieved in acute myocardial infarction (AMI) by coronary angioplasty. Coronary stenting improves initial success rate and reduces rate of restenosis. However, there are limited data regarding intermediate outcome of late angioplasty with stenting.
Method:
Between June 1998 and August 1999, one hundred and twenty-three patients with AMI, and forty-four patients (37 males, 7 females) underwent late coronary stenting. Mean age was 57 +/- 10 years. Echocardiography was performed before the procedure and at 6-months follow-up.
Results:
There were 36 Q-MI and 8 non Q-MI. The infarct-related artery (IRA) was left anterior descending artery (LAD) 55 per cent, left circumflex artery (LCX) 15 per cent, and right coronary artery (RCA) 30 per cent. Coronary stenting was successfully performed in all patients. Pre- and post-procedural diameter stenosis were 90.5 +/- 8.9 per cent and 2.2 +/- 6.5 per cent. Stent indications were suboptimal results (68.2%), intimal dissection (20.4%), and acute closure (11.4%). Over all in-hospital mortality was 2.27 per cent from sudden cardiac death. Mean follow-up was 11.41 +/- 4.79 months. There were 1 MI (2.3%), 2 CHF (4.65%), 1 unstable angina pectoris (2.3%), 1 transient ischemic attack (TIA) (2.3%), and no cardiac death. LVEF showed improvement at 6-months follow-up (47.75 +/- 11.55% vs 54.89 +/- 14.76%, p value < 0.001)
Conclusion:
Late coronary stenting of the IRA of patients with AMI is feasible, with few complications. There was improved LVEF and intermediate clinical outcome.