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[Complications of emergency coronary angioplasty for acute myocardial infarction]
M Ishihara1, H Sato, H Tateishi
1Department of Cardiology, Hiroshima City Hospital.
Insights
Emergency percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) can cause complications. Successful repeat PTCA after acute occlusion improves survival, but side branch occlusions can be fatal.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Context:
- Acute myocardial infarction (AMI) management often involves emergency percutaneous transluminal coronary angioplasty (PTCA).
- Assessing complications during PTCA is crucial for patient outcomes.
- 347 patients undergoing emergency PTCA for AMI within 24 hours of symptom onset were studied.
Purpose:
- To evaluate the incidence and consequences of complications during emergency PTCA for AMI.
- To determine the impact of acute occlusion and side branch occlusion on patient mortality and long-term patency.
Summary:
- Acute occlusion occurred in 8.4% of patients; successful repeat PTCA led to survival, with comparable reocclusion rates to controls.
- 13 patients with unsuccessful reperfusion after acute occlusion had a 46% mortality rate.
- Side branch occlusion occurred in 6.1% of patients; specific occlusions (left circumflex, right ventricular) were associated with high mortality, though most occluded side branches remained patent chronically.
Impact:
- Successful repeat PTCA significantly improves prognosis after acute occlusion during emergency PTCA for AMI.
- Certain side branch occlusions during PTCA are associated with high fatality, emphasizing the need for careful procedural technique.
- While complications like acute and side branch occlusion can occur, prompt and successful interventions can mitigate adverse outcomes.
Abstract:
To assess the incidence and consequences of complications occurring during emergency percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI), we studied 347 patients who underwent PTCA within 24 hours after the onset of AMI. Acute occlusion occurred in 29 patients (8.4%), of whom 16 patients underwent successful repeat PTCA. All of them survived until hospital discharge. The in-hospital reocclusion rates of these 16 patients were comparable to those of patients who had not experienced acute occlusion (18.8 vs 12.8%, ns). In the remaining 13 patients, reperfusion were not successful after acute occlusion, and 6 died. Side branch occlusion occurred in 21 patients (6.1%). Left circumflex artery occlusion occurring during PTCA for the proximal left anterior descending artery was fatal in 3 patients. Right ventricular branch occlusion during PTCA for the middle of the right coronary artery resulted in intractable right ventricular infarction in one patient, and he died. Among 14 patients who underwent repeat angiography, 13 had a patent side branch which had been occluded during PTCA. One patient had coronary rupture and died. During PTCA of the proximal left anterior descending artery, acute occlusion of the artery without reperfusion or occlusion of the left circumflex artery was often fatal. However, the prognosis of acute occlusion was relatively good, if repeat PTCA was successful and most of the occluded side branches remained patent in the chronic state.