[Primary coronary angioplasty for acute myocardial infarction associated with severe left ventricular dysfunction. Results in 50 patients].

BACKGROUND

Considerable controversy exists about the therapeutic value of primary coronary angioplasty for acute myocardial infarction. The available data suggest that primary angioplasty may improve the outcome in patients with cardiogenic shock, while some clinical studies have found no benefit in routine angioplasty in patients with acute myocardial infarction that were considered at high risk because of severe left ventricular dysfunction associated with myocardial infarction.

METHODS AND RESULTS

During a 16-month period, 50 patients with acute myocardial infarction and severe left ventricular dysfunction underwent primary coronary angioplasty. Patients were enrolled if angiographic left ventricular ejection fraction was > or = 40% and symptom duration <6 hours, or >6 hours if there was evidence of ongoing ischemia. Optimal angiographic success (<30% stenosis associated with TIMI grade 3 flow) was achieved in 45 patients (90%), and a suboptimal result (>30% and <50% stenosis associated with TIMI grade 3 flow, or <30% stenosis associated with TIMI grade 2 flow) was achieved in 3 patients (6%), while in 2 patients angioplasty failed to reopen the infarct related vessel or was associated with a refractory no-reflow phenomenon. In 5 patients an optimal angiographic result was achieved after coronary stenting. Emergency repeated coronary angioplasty was required in 1 patient with reocclusion of a stented vessel, and after unsuccessful repeated coronary angioplasty, the patient underwent bypass surgery on a semi-elective basis. In 6 patients with multivessel disease, after successful primary angioplasty of the infarct-related vessel, a more complete revasculariziation was achieved with a second coronary angioplasty or bypass surgery before discharge. The in-hospital mortality rate was 6%. The follow-up of 47 patients surviving initial hospitalization was 171 +/- 163 days. There were 2 deaths (4%), both due to congestive heart failure, and 1 nonfatal reinfarction. Two patients (4%), were readmitted to the hospital for recurrent ischemia and both underwent successful repeated coronary angioplasty for restenosis.

CONCLUSIONS

The results of this study suggest that in patients with acute myocardial infarction associated with severe left ventricular dysfunction, primary coronary angioplasty may be considered a first choice treatment because of high reperfusion rate, relative low in-hospital mortality and few recurrent myocardial ischemic events.