Late outcome after percutaneous transluminal coronary angioplasty during acute myocardial infarction

Am J Cardiol. 1993 Sep 15;72(9):634-9. doi: 10.1016/0002-9149(93)90876-e.

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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Angioplasty, Balloon, Coronary / adverse effects
  • Angioplasty, Balloon, Coronary / mortality
  • Angioplasty, Balloon, Coronary / statistics & numerical data*
  • Cause of Death
  • Combined Modality Therapy
  • Coronary Artery Bypass / statistics & numerical data
  • Coronary Disease / drug therapy
  • Coronary Disease / pathology
  • Coronary Disease / physiopathology
  • Coronary Disease / surgery
  • Coronary Disease / therapy
  • Follow-Up Studies
  • Hospital Mortality
  • Humans
  • Infusions, Intravenous
  • Middle Aged
  • Minnesota / epidemiology
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / pathology
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / surgery
  • Myocardial Infarction / therapy*
  • Recurrence
  • Risk Factors
  • Streptokinase / administration & dosage
  • Streptokinase / therapeutic use
  • Stroke Volume / physiology
  • Survival Rate
  • Thrombolytic Therapy / adverse effects
  • Thrombolytic Therapy / mortality
  • Thrombolytic Therapy / statistics & numerical data*
  • Treatment Outcome
  • Vascular Patency
  • Ventricular Function, Left / physiology

Substances

  • Streptokinase