Primary angioplasty in a public hospital: initial results

Background

Many studies in the literature show that primary angioplasty is the best method for myocardial reperfusion.

Objectives

The aim of the study was to evaluate the angiographic and clinical results of primary angioplasty in patients with acute myocardial infarction (AMI).

Methods

We prospectively studied 1055 patients with AMI, in a coronary unit care, from March 1994 to March 2003. The angiographic successful of revascularization was defined as a reduction of at least 20 percent points in the stenosis of at least one lesion, resulting in a residual stenosis of less than 50% of the luminal diameter and Thrombolysis in Myocardial Infarction 3 flow. Clinical successful was defined as angiographic successful without inhospital complications of death, reinfarction, repeated percutaneous procedure, or referral for coronary artery bypass graft (CABG) surgery. For statistical analyse were used chi-square analyses or Fisher's exact test and Student's t-test.

Results

Between March 1994 and March 2003, 1055 consecutive patients with AMI were hospitalized and 57 were referred to our catheterization laboratory for direct angioplasty within 12 hours of symptom onset. Of these patients, the mean age was 61 years. Males comprised 56.1% (31).

Traditional risk factors prevalence were 17.5% for diabetes mellitus, 73.7% for hypertension, 43.9% for current smoker, 52.6% hypercholesterolemia and 56.1% for family history of CAD. Of the patients, 31.5% had a history of myocardial infarction. Anterior wall AMI occurred in 35 patients and inferior in 22. Of the patients, 54.4% were submitted to direct angioplasty within 12 hours from symptom onset, the ejection fraction mean was 56.8 ± 11.9%, and infarct-related artery was descendent anterior in 49.1% and right coronary in 38.6%. The extent of CAD was one vessel in 48.1% and three vessels in 15.8%. Angiographic successful was demonstrated in 45 patients (81.8%) with stent implantation in 61.4%, reinfarction in 3.51%, repeated percutaneous procedure in 7%, CABG in 1.8% and mortality was 12.3% (included five patients in cardiogenic shock). The clinical success was 75.5%.

Conclusion

We demonstrated good results of direct angioplasty with the greatest mortality because of previous infarction, cardiogenic shock and the time from symptom onset to angioplasty.