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Direct percutaneous transluminal coronary angioplasty for patients with exclusions from thrombolysis
T Feldman1, R C Hinkle, J W Ziegler
1Department of Medicine, Hans Hecht Hemodynamics Laboratory, University of Chicago Hospitals, IL 60637.
Insights
Many acute myocardial infarction patients are ineligible for thrombolytic therapy. Alternative reperfusion methods like direct percutaneous transluminal coronary angioplasty significantly increase early treatment rates.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- Intravenous thrombolytic therapy is a standard treatment for acute myocardial infarction (AMI).
- A significant portion of AMI patients do not qualify for thrombolysis due to various exclusion criteria.
- Direct percutaneous transluminal coronary angioplasty (PTCA) offers an alternative reperfusion strategy.
Purpose of the Study:
- To evaluate the number of AMI patients ineligible for intravenous thrombolysis who could benefit from alternative reperfusion methods.
- To assess the impact of utilizing various reperfusion strategies on early treatment rates in AMI.
Main Methods:
- Retrospective review of 251 patients diagnosed with AMI.
- Analysis of patient records to identify exclusion criteria for intravenous thrombolysis.
- Comparison of early treatment rates between intravenous thrombolysis alone and combined reperfusion therapies.
Main Results:
- 75% of patients had exclusion criteria for intravenous thrombolysis.
- Common exclusion criteria included ECG ineligibility (34%), chest pain duration >6 hours (17%), and age >75 years (16%).
- Utilizing alternative reperfusion therapies (intracoronary thrombolysis, direct PTCA, CABG) increased early treatment from 19% to 28% (p=0.03).
Conclusions:
- A substantial majority of acute myocardial infarction patients are not candidates for intravenous thrombolytic therapy.
- Employing a range of reperfusion strategies, including direct PTCA, significantly enhances the proportion of patients receiving timely treatment for AMI.
- Expanding reperfusion options beyond intravenous thrombolysis is crucial for improving early management of acute myocardial infarction.
Abstract:
Direct percutaneous transluminal coronary angioplasty (PTCA) is a recognized alternative to intravenous thrombolytic therapy for early acute myocardial infarction (AMI). Fewer than one half of patients with AMI are candidates for thrombolytic therapy. We reviewed the records of 251 patients with the discharge diagnosis of AMI to determine the number of patients ineligible for thrombolysis who might be treatable with reperfusion methods other than intravenous thrombolysis. Forty percent of the patients (n = 101) were first seen within 6 hours and 51% (n = 128) were first seen within 12 hours of symptom onset. One third of the patients (n = 83) had no clear symptom at the time of initial examination. Exclusion criteria for intravenous thrombolysis were present in 187 of 251 patients (75%). Exclusion criteria for thrombolytic therapy included ECG ineligibility (n = 133), chest pain for more than 6 hours (n = 67), and age over 75 years (n = 64), comprising 79% of all exclusions. Of those first seen within 6 hours of symptom onset, 43 of 101 patients (43%) had an ineligible ECG, and 13 of 101 (13%) had age over 75 as exclusion criteria for thrombolysis. Forty-eight of 251 patients (19%) received intravenous thrombolysis. After early coronary angiography, intracoronary thrombolysis, direct PTCA, and emergency coronary artery bypass grafting were used in an additional 30 patients. The use of other forms of reperfusion therapy increased the number of patients treated early to 70 of 251 (28%) (p = 0.03). The use of a variety of forms of reperfusion therapy substantially increases the number of patients treated early compared with sole use of intravenous thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)