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Primary coronary angioplasty for acute myocardial infarction with contraindication to thrombolysis
D Himbert1, J M Juliard, P G Steg
1Service de Cardiologie, Hôpital Bichat, Paris, France.
Insights
Primary angioplasty is a safe and effective treatment for acute myocardial infarction (AMI) patients unable to receive thrombolysis. This emergent procedure rapidly restores blood flow, significantly improving patient outcomes compared to traditional medical management.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Patients with acute myocardial infarction (AMI) and contraindications to thrombolysis face high mortality and morbidity with standard medical care.
- A significant subset of AMI patients (20% in this study) cannot receive thrombolytic therapy.
Purpose of the Study:
- To evaluate the safety and efficacy of emergent primary angioplasty in patients with AMI who have contraindications to thrombolysis.
- To compare outcomes of primary angioplasty versus conventional medical treatment in this high-risk patient group.
Main Methods:
- Retrospective analysis of 45 consecutive patients with Q-wave AMI and contraindications to thrombolysis treated with emergent primary angioplasty.
- Assessment of procedural success, in-hospital mortality, bleeding, stroke, reocclusion rates, ejection fraction, and long-term survival and event-free survival.
Main Results:
- Successful angioplasty was achieved in 93% of patients, with a 9% in-hospital mortality rate.
- No major bleeding or stroke events occurred. Long-term survival rates at 1 and 3 years were 87% and 85%, respectively.
- Primary angioplasty demonstrated improved early and late outcomes compared to historical medical treatment data for this specific patient subset.
Conclusions:
- Emergent primary angioplasty is a safe and highly effective strategy for restoring infarct-related artery patency in AMI patients ineligible for thrombolysis.
- This intervention leads to significant improvements in both early and late clinical outcomes for this high-risk population.
Abstract:
Patients with acute myocardial infarction (AMI) and contraindication to thrombolysis have a high mortality and morbidity with conventional medical treatment. Among 226 consecutive patients hospitalized within 6 hours of the onset of Q-wave AMI, 45 (20%) had contraindications to thrombolysis. All were treated by emergent primary angioplasty. Mean age of the 45 patients was 60 +/- 11 years and 8 (18%) were > or = 70 years old; 17 (38%) had multivessel disease and 5 (11%) presented with cardiogenic shock. Successful angioplasty was achieved in 42 of the 45 patients (93%) 52 +/- 27 minutes after admission and 238 +/- 100 minutes after the onset of pain. Overall in-hospital mortality was 9% (4 of 45). Neither major bleeding nor stroke occurred. There was 1 case of early symptomatic reocclusion, treated with emergent repeat angioplasty without reinfarction. Predischarge angiography in 33 patients showed only 1 silent reocclusion (3%). Ejection fraction at discharge was 46 +/- 13%. Repeat catheterization at 6 months in 19 patients showed 4 restenoses (21%) and 4 reocclusions (21%) of the infarct-related artery. There were 3 late deaths (2 noncardiac), which gave survival rates of 87 and 85% at 1 and 3 years, respectively, and event-free survival rates of 71 and 69% including in-hospital deaths. There were no cases of late reinfarction. Consequently, in this series, primary coronary angioplasty proved safe and highly effective in rapidly restoring sustained infarct-vessel patency during AMI, and led to a greater improvement in early and late outcomes than that reported in the literature for medically treated subjects in this high-risk subset for which thrombolytic therapy is contraindicated.