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Published on: April 17, 2021
Acute myocardial infarction: patient selection for reperfusion with coronary angioplasty
Carlos Cafri1, Eugene Crystal, Sergio Kobal
1Department of Cardiology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. cafricar@netvision.net.il
Insights
Selecting high-risk acute myocardial infarction (AMI) patients for percutaneous transluminal coronary angioplasty (PTCA) is feasible. This strategy shows promisingly low mortality rates, optimizing resource use for mechanical reperfusion.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Mechanical reperfusion via PTCA offers clinical benefits for AMI.
- Limited resources hinder widespread PTCA adoption for AMI treatment.
Purpose of the Study:
- To assess the feasibility of a PTCA-based reperfusion strategy.
- To identify high-risk AMI patients who could benefit most from this approach.
Main Methods:
- 110 AMI patients selected for mechanical reperfusion from 1,080.
- Selection criteria included hemodynamic disturbance, large anterior MI, thrombolysis contraindication, prior MI, re-infarction, and failed thrombolysis.
Main Results:
- 23% of patients presented with cardiogenic shock; 8% had cardiac arrest.
- Overall 30-day mortality was 15%, but only 6.3% for patients without cardiogenic shock.
Conclusions:
- Selecting high-risk AMI patients for mechanical reperfusion is feasible.
- This targeted approach yields low mortality rates compared to literature.
- Defined criteria can improve the utilization of limited PTCA resources.
Background:
Despite the clinical advantages of mechanical reperfusion in the treatment of acute myocardial infarction, widespread use of percutaneous transluminal coronary angioplasty has been limited by a lack of human and institutional resources.
Objective:
To evaluate the feasibility of a PTCA-based reperfusion strategy for AMI patients selected according to high risk clinical criteria.
Methods:
The study group included 110 patients selected for mechanical reperfusion out of 1,080 AMI patients according to the following criteria: hemodynamic disturbance (40%), large anterior wall MI (54%), contraindication to thrombolysis (15%), previous MI (13%), re-infarction (4.5%), non-diagnostic electrocardiogram (0.9%), and unsuccessful thrombolysis (30%).
Results:
Cardiogenic shock was present in 23% of the cases and cardiac arrest with prolonged resuscitation in 8%. The cohort 30 day mortality rate was 15%. The 30 day mortality rate for patients without cardiogenic shock was 6.3%.
Conclusions:
Selection of high risk patients who would benefit most from mechanical reperfusion appears feasible, resulting in low mortality rates when compared with those in the literature. Widespread implementation of well-defined selection criteria should promote better utilization of the limited resources available for primary PTCA.
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