Late outcome after percutaneous transluminal coronary angioplasty during acute myocardial infarction

Brian O'Murchu, Bernard J. Gersh, Guy S. Reeder, Kent R. Bailey, David R. Holmes

Research output: Contribution to journalArticle

14 Scopus citations

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 ≥ 62 years, multivessel disease, ejection fraction ≤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 ≤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.

Original languageEnglish (US)
Pages (from-to)634-639
Number of pages6
JournalThe American journal of cardiology
Volume72
Issue number9
DOIs
StatePublished - Sep 15 1993

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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