Coronary angioplasty during acute myocardial infarction

BACKGROUND: Percutaneous coronary angioplasty (PTCA) is an effective method to achieve myocardial reperfusion in acute myocardial infarction. In order to identify the predictors of primary success and major complications, we reviewed our experience in 107 patients (pts) who underwent PTCA of a totally occluded infarct-related coronary artery (IRA) within 24 hours (h) after the onset of symptoms. METHODS AND RESULTS: PTCA was successful in 92 pts (86%); PTCA failed without complications in 9 pts (8.4%), major complication (death and urgent coronary artery surgery) occurred in 6 pts (5.6%). Rescue PTCA was performed in 31% of cases and had similar success rate when compared to direct PTCA (85 vs 86%, p = NS). Pts with successful PTCA had repeat angiography 24 h after the procedure. According to primary and 24 h results, pts were divided into 3 groups: primary success with 24 h stable result (Group A: 76 pts, 71%); primary success with 24 h deterioration (Group B: 16 pts, 15%), among which 4 pts showed total reocclusion; primary failure (Group C: 15 pts, 14%). A longer time delay from symptoms onset (p < 0.05), cardiogenic shock (p < 0.001), previous bypass surgery (p < 0.05) were correlated with worse short-term outcome by univariate analysis. When compared to Group A, pts in Group C showed a lower EF (42 +/- 14 vs 51 +/- 16%, p < 0.05). IRA diameter was greater in Group A (3.1 +/- 0.4 mm) when compared to Group B (2.7 +/- 0.4 mm, p < 0.05) and Group C (2.7 +/- 0.5 mm, p < 0.05). Absence of cardiogenic shock (p < 0.001), decreasing time from symptoms onset (p < 0.01) and increasing ejection fraction (EF) (p < 0.05) were independent predictors of primary success by multivariate analysis. Cardiogenic shock (p < 0.001) and decreasing EF (p < 0.05) were independent predictors of major complications. CONCLUSIONS: PTCA of IRA is effective within 24 h from symptoms onset. Procedural failure is infrequent, usually occurring in patients with high-risk baseline characteristics.