[Primary angioplasty in acute myocardial infarct]

We report our experience with primary angioplasty (PPTCA) in acute myocardial infarction performed without prior thrombolytic therapy. Between January 1991 and April 1993, 44 patients underwent PPTCA. Duration of symptoms was 163 +/ 106 min; age range of patients was 30 to 89 years (mean 60.6 +/- 13.5 years). Twelve patients presented with cardiogenic shock (27%), 17 patients (39%) had at least one relative contraindication for thrombolysis. Primary success rate was 98%. No stroke or major bleeding was observed. Reocclusion occurred in two patients, whereby this complication was silent in one of the cases. Significant residual stenosis remained in two additional patients. Three patients (7%) underwent elective bypass surgery (ACBG). Overall two-week mortality was 9%, and only 3% in the subgroup of patients without cardiogenic shock. Complete follow-up (FU) exceeding four months is now available in 36 patients (mean FU 13.7 +/- 7.3 months). During the FU period three patients had ACBG and five patients had PTCA. Thus, seven of 36 patients (19%) needed an additional procedure. Three patients had died, all of them were older than 70 years and initially presented with cardiogenic shock. Overall survival (in hospital and FU) was 84% (97% when patients with cardiogenic shock were excluded). Long-term survival (in hospital and FU) of the twelve patients initially presenting with cardiogenic shock was 50%. In conclusion, PPTCA is a promising therapeutic option in patients with acute myocardial infarction, especially when thrombolysis is contraindicated or when cardiogenic shock is present. It appears to be feasible even in centers with only one available catheterization unit.