Primary mechanical recanalization of occluded coronary arteries without prior thrombolytic therapy in patients with acute myocardial infarction. A single-center study reporting acute results and complications.

This study reports on 261 consecutive patients admitted to the Wuppertal Heart Center with acute myocardial infarction (186 men, 75 women; average age: 58.2 +/- 11.6 years) and then treated by primary coronary artery angioplasty. Sixteen patients with cardiogenic shock were included, as well as 42 patients aged > or = 70 years, 51 patients with contraindications for thrombolysis, and 13 patients with prior coronary bypass surgery. All patients were treated between 12/89 to 6/94 and had not received prior thrombolytic therapy. The period of time between onset of pain and revascularization of the infarct-related vessel averaged 224 +/- 205 min. Half of the patients had multi-vessel disease, and about 31% had had a prior myocardial infarction. 100 patients suffered from an anterior wall infarction, 109 patients from an inferior wall infarction, 50 patients from a posterolateral infarction, and in two cases the infarct localization could not be determined from the ECG. Mean biplane left ventricular ejection fraction averaged 56 +/- 13%, left ventricular end-diastolic pressure 20 +/- 7 mm Hg. In about 50% of the patients collaterals to the infarct-related coronary artery could be documented. With the first contrast injection into the infarct-related vessel TIMI flow 0/I was demonstrated in 94.9%, TIMI flow II in 5.7% and TIMI flow III in 0.4%. Reopening of the infarct-related coronary artery with establishment of TIMI-flow III was primarily successful in 91.9%. Average time for coronary angiography and angioplasty in the cathlab was 69 +/- 28 min. In 29 patients an autoperfusion balloon catheter was used to treat manifest or threatening reocclusion. Thirty-day-mortality in the total study group was 3.4%. In patients aged > or = 70 years mortality raised to 14.3%; in patients in cardiogenic shock mortality increased to 18.7%, in patients with inferior wall infarction up to 5.5%, and in cases with multi-vessel disease up to 5.0%. The in-hospital and 30-day course were complicated by major peripheral bleeding in seven patients (2.7%) requiring blood transfusions and surgical femoral vascular repair, and in another two patients with a false aneurysm which was treated by surgical means. No hemorrhagic stroke occurred, but three ischemic strokes with complete restitutio ad integrum within the 30-day-observation period were registered. As major cardiac complication early re-occlusion of the initially reopened infarct-related coronary artery was diagnosed in 10 patients; 11 patients developed a re-infarction within the first 30-days, in three cases leading to a fatal outcome.(ABSTRACT TRUNCATED AT 400 WORDS)