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[Coronary angioplasty during acute myocardial infarction]
M Zimarino1, X Favereau, T Corcos
1Cardiologie Interventionelle, CMC Parly-Grand Chesnay, Le Chesnay, France.
Insights
Percutaneous coronary angioplasty (PTCA) effectively restores blood flow in acute myocardial infarction within 24 hours. Key predictors of success include shorter symptom onset time, absence of cardiogenic shock, and higher ejection fraction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Percutaneous coronary angioplasty (PTCA) is a primary treatment for myocardial reperfusion in acute myocardial infarction.
- Identifying predictors of PTCA success and complications is crucial for patient outcomes.
Purpose of the Study:
- To identify predictors of primary success and major complications in patients undergoing PTCA for totally occluded infarct-related coronary arteries (IRA).
- To evaluate the effectiveness of PTCA within 24 hours of symptom onset.
Main Methods:
- Retrospective review of 107 patients undergoing PTCA for totally occluded IRA within 24 hours of symptom onset.
- Analysis of procedural success, complications, and short-term outcomes, including repeat angiography.
- Univariate and multivariate analyses to determine predictors of success and complications.
Main Results:
- PTCA achieved an 86% primary success rate, with major complications in 5.6% of patients.
- Independent predictors of primary success included shorter time from symptom onset, absence of cardiogenic shock, and higher ejection fraction (EF).
- Cardiogenic shock and lower EF were independent predictors of major complications.
Conclusions:
- PTCA of the infarct-related artery is effective within 24 hours of symptom onset.
- Procedural failure is infrequent and typically occurs in patients with high-risk baseline characteristics.
Background:
Percutaneous coronary angioplasty (PTCA) is an effective method to achieve myocardial reperfusion in acute myocardial infarction. In order to identify the predictors of primary success and major complications, we reviewed our experience in 107 patients (pts) who underwent PTCA of a totally occluded infarct-related coronary artery (IRA) within 24 hours (h) after the onset of symptoms.
Methods And Results:
PTCA was successful in 92 pts (86%); PTCA failed without complications in 9 pts (8.4%), major complication (death and urgent coronary artery surgery) occurred in 6 pts (5.6%). Rescue PTCA was performed in 31% of cases and had similar success rate when compared to direct PTCA (85 vs 86%, p = NS). Pts with successful PTCA had repeat angiography 24 h after the procedure. According to primary and 24 h results, pts were divided into 3 groups: primary success with 24 h stable result (Group A: 76 pts, 71%); primary success with 24 h deterioration (Group B: 16 pts, 15%), among which 4 pts showed total reocclusion; primary failure (Group C: 15 pts, 14%). A longer time delay from symptoms onset (p < 0.05), cardiogenic shock (p < 0.001), previous bypass surgery (p < 0.05) were correlated with worse short-term outcome by univariate analysis. When compared to Group A, pts in Group C showed a lower EF (42 +/- 14 vs 51 +/- 16%, p < 0.05). IRA diameter was greater in Group A (3.1 +/- 0.4 mm) when compared to Group B (2.7 +/- 0.4 mm, p < 0.05) and Group C (2.7 +/- 0.5 mm, p < 0.05). Absence of cardiogenic shock (p < 0.001), decreasing time from symptoms onset (p < 0.01) and increasing ejection fraction (EF) (p < 0.05) were independent predictors of primary success by multivariate analysis. Cardiogenic shock (p < 0.001) and decreasing EF (p < 0.05) were independent predictors of major complications.
Conclusions:
PTCA of IRA is effective within 24 h from symptoms onset. Procedural failure is infrequent, usually occurring in patients with high-risk baseline characteristics.