Elective Percutaneous Transluminal Coronary Angioplasty in Acute Myocardial Infarction

Percutaneous transluminal coronary angioplasty (PTCA) was performed in 102 patients with a diagnosis of acute myocardial infaretion (AMI) in whom myocardial ischemia occurred spontaneously during hospitalization or at the time of predischarge submaximal exercise testing and in whom the infarct-related artery (IRA) anatomies were suitable following coronary angiography (CA). In 94 cases (92 %), the procedure was favorable while the results were unsuccessful in 8 of the patients (8 %) in whom the lesion could not be crossed with guide-wire in 3 and effective patency could not be achieved in ı (4 %); 2 deaths (2 %) occurred during the procedure and 2 cases (2 %) underwent emergency coronary artery bypass grafting surgery (CABG); there was no reinfarction. As minor complications, 7 intimal dissections (7 %) 4 of which were major ones, ı side-branch occlusion ( 1 %) were seen. Hematoma occurred at the puncture site in 7 of the cases (7 %). IRA patency was demonstrated in 42 of 62 patients (68 %) in the 6 month control CA. Repeat angioplasty was successful in 15 of20 cases (75 %) in whom restenosis occurred. A total of 8 patients (13 % ), 3 of the replasty cases together with 5 cases in whom sufficient dilatation could not be achieved, underwent elective CABG. In conclusion, compared with other strategies such as primary, immediate, rescue and delayed PTCA in AMI in the literature, PTCA in elective circumstances results in higher success rate in cases who have spontaneous or exercise-induced ischemia and suitable coronary artery anatomy, when as sessed w ith respect to achieving effective IRA patency or complications that may ensue. IRA patency is maintained in most of patients in the 6-month-control CA and replasty can be performed again with an important rate of success in cases in whom restenosis occurs.