Related Experiment Videos
Late outcome after percutaneous transluminal coronary angioplasty during acute myocardial infarction
B O'Murchu1, B J Gersh, G S Reeder
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Long-term survival after percutaneous transluminal coronary angioplasty for acute myocardial infarction is excellent. Key predictors of late mortality include low ejection fraction and prior heart attack.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Early reperfusion improves outcomes in acute myocardial infarction (AMI).
- Limited data exists on long-term (>5 years) survival after percutaneous transluminal coronary angioplasty (PTCA) for AMI.
Purpose of the Study:
- To evaluate long-term survival and outcomes in patients undergoing PTCA for AMI.
Main Methods:
- Retrospective study of 160 patients who underwent PTCA for AMI between 1981-1987.
- Patients received PTCA with or without streptokinase therapy.
- Follow-up averaged 69 months.
Main Results:
- Hospital survival was 93%.
- Long-term mortality was 15%, with reinfarction in 14% and repeat procedures in 15%.
- Multivariate analysis identified ejection fraction ≤40% and prior AMI as predictors of late death.
Conclusions:
- Long-term survival after PTCA for AMI is excellent.
- Early surgical revascularization for high-risk patients may improve outcomes.
Abstract:
Early reperfusion for acute myocardial infarction (AMI) results in improved ventricular function and survival. There is a dearth of data on long-term survival (> 5 years) after percutaneous transluminal coronary angioplasty (PTCA) performed either as a primary procedure or in conjunction with thrombolytic therapy. We studied 160 patients who underwent PTCA during AMI between 1981 and 1987 either with (n = 101) or without (n = 59) streptokinase therapy. Mean time to reperfusion was 4.6 hours, and patency was achieved in 134 patients (84%). Mean discharge ejection fraction was 46 +/- 14%. Coronary artery bypass grafting was performed before dismissal in 34 patients (21%), including 21 of 130 patients (16%) with 1- or 2-vessel disease and 13 of 30 patients (43%) with 3-vessel disease (p < 0.05). Eleven patients (7%) died in the hospital. The 149 hospital survivors were followed for a mean of 69 +/- 21 months (median 72). During follow-up, 22 patients (15%) died, 21 (14%) had reinfarction, 23 (15%) underwent coronary artery bypass grafting, and 21 (14%) underwent repeat PTCA of the infarct-related artery. On univariate analysis, age > or = 62 years, multivessel disease, ejection fraction < or = 40%, previous AMI, and being a nonsmoker at the time of AMI were predictive of late mortality (p < 0.05 each variable). On multivariate analysis, only ejection fraction < or = 40% and prior AMI were predictive of late death. In patients treated with PTCA for AMI, late survival is excellent. Early surgical revascularization of high-risk patients may contribute to these encouraging results.