Direct PTCA in Acute Myocardial Infarction

We evaluated 130 patients with signs of AMI who presented within 6 hours after the onset of symptoms, or between the 5th and 12th hours if there was evidence of ongoing ischemia. Enrollment began on September 1994 and ended August 1996. Patients were immediately transported to the catheter laboratory and underwent coronary angiography followed by direct PTCA if indicated. Mean patient age was 55±1O, 87% of patients were male, 12% had prior MI, 54% had anterior MI and 87% were in Killip class I or II. Five patients had spontaneous reperfusion and were treated medically. Thirteen patients with extensive CAD and 1 patient with LMCA lesion underwent primary CABG. Nine patients with small, distal infarct-related artery (IRA) occlusion were treated medically. One-hundred patients were assigned to undergo direct PTCA. The success rate was 91 %. Time from admission to the first balloon inflation was 47±21 min. In 9 patients PTCA failed; 6 underwent CABG, 3 patients were treated medically. Follow-up angiography was performed in all PTCA patients before hospital discharge. Reocclusion of the IRA during hospitalization was seen in 6 patients (symptomatic in 3). One patient died after successful PTCA, overall mortality was 5.5% in all patients. These results suggest that direct PTCA is an effective method for establishing early and optimal blood flow through the IRA, with an acceptable mortality and lower complication rate.