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[Coronary angioplasty in acute myocardial infarction]
E Bertaglia1, A Ramondo, L Cacciavillani
1UCIC, Cattedra di Cardiologia, Padova.
Insights
Primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) offers superior reperfusion compared to thrombolytic therapy. Early PTCA within 3 hours of symptom onset demonstrates excellent in-hospital and mid-term outcomes with minimal complications.
Area of Science:
- Cardiology
- Interventional Cardiology
Context:
- Acute myocardial infarction (AMI) requires timely reperfusion therapy.
- Primary percutaneous transluminal coronary angioplasty (PTCA) is an alternative to thrombolytic therapy.
- Early invasive strategies aim to improve patient outcomes in AMI.
Purpose:
- To evaluate the in-hospital and mid-term results of an early invasive strategy using primary PTCA in patients with AMI.
- To assess the efficacy and safety of primary PTCA within 3 hours of symptom onset.
Summary:
- Thirty-four patients with AMI underwent coronary angiography within 3 hours.
- Thirty-one patients underwent primary PTCA, with 97% achieving successful reperfusion (TIMI flow 3).
- Stent deployment was performed in 52% of lesions. At 6 months, only 3% required repeat PTCA.
Impact:
- Primary PTCA within 3 hours of AMI symptom onset yields high success rates.
- This early invasive approach demonstrates favorable in-hospital and mid-term outcomes.
- The strategy is associated with a low rate of complications and reintervention.
Abstract:
Primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) allows to obtain a higher reperfusion rate in the culprit vessel than thrombolytic therapy, reducing the incidence of death, non fatal reinfarction and recurrent ischemia. The aim of this study was to test the in-hospital and mid-term results of an early invasive strategy with PTCA in patients with AMI. Thirty-four patients with AMI underwent coronary angiography within 3 hours from the onset of symptoms. Twenty-four patients had anterior AMI and 3 were in cardiogenic shock. Three patients, 1 without significant lesions and 2 with multivessel diffuse coronary disease, were left out of the procedure, and 31 patients underwent PTCA. Twenty-six lesions were total occlusions with TIMI flow 0.A TIMI flow 1 was present in the other 5 vessels. Stent deployment was decided for 16 lesions (52%). Primary success (TIMI flow 3 with mean residual stenosis of 15 +/- 20%) was obtained in 30 patients (97%). In 1 patient recanalization of the anterior descending coronary artery was not possible due to tortuosity of the abdominal and thoracic aorta. At pre-discharge angiography a good result was confirmed in 24/25 patients. After 6 months only 1 patient (3%) underwent a new PTCA for recurrent angina. In conclusion, primary PTCA for AMI within 3 hours of symptom onset allows good in-hospital and mid-term results with a low rate of complications.