Emergency percutaneous transluminal coronary angioplasty in 52 patients with acute myocardial infarction
- Author:
Yingfeng LIU
1
;
Xuexian QIAN
;
Xiangyang FU
;
Wensheng YE
;
Lei LIU
;
Zhijian WU
;
Gongxin LI
;
Zhiliang LI
;
Dongfeng LU
;
Xia ZHAO
Author Information
1. 第一军医大学附属珠江医院
- From:
Chinese Medical Journal
1998;111(3):0-0
- CountryChina
- Language:Chinese
-
Abstract:
In the early 1990's, emergency percutaneous transluminal coronary angioplasty (PTCA) has been proven to be the best strategy for acute myocardial infarction (AMI). It has not only resulted in a higher vascular recanalization, but has also further reduced mortality and morbidity, and has greatly improved life quality of patients with AMI.Objective To investigate the effect of emergency PTCA in AMI.Methods Emergency PTCA was performed in 52 AMI patients (male: 43, female: 9) from October 1993 to December 1997 in our hospital. The patients were aged between 31-89 years (±s, 53.7±8.2). Among them, 25 had anterior infarction, 27 inferior infarction. Angiographically infarct-related vessels were left anterior descending artery (LAD) in 27 cases, right coronary artery (RCA) in 22, and left circumflex artery (LCx) in 3. The mean time from the onset of chest pain was 6.12±5.13 h (2-12 h). Primary PTCA (balloon angioplasty without previous thrombolytic therapy) was performed in 34 cases, and rescue PTCA (balloon angioplasty after previous thrombolytic therapy that had failed to restore blood flow) in 15 cases, and immediate PTCA ( balloon angioplasty after previous successful thrombolysis but with severe residual stenosis and reoccurring angina pectoris) in 3 cases. Only the infarct-related vessels was dilated during emergency PTCA which is similarto conventional balloon angioplasty. All patients were given aspirin of 250 mg/d and were heparinized during the first 3-5 days after PTCA. Ticlopidine (250 mg, twice daily) was also given for 3 months if patients had experienced intracoronary stenting.Results Emergency PTCA was successfully performed in 48 of 52 patients (33/34 in primary PTCA, 12/15 in rescue PTCA, and 3/3 in immediate PTCA) which accounts for the initial success rate of 92%. Intracoronary stents were implanted in 18 of the 48 patients due to the presence of different vessel complications. PTCA was failed in 4 patients (3 occurred in rescue PTCA, 1 occurred in primary PTCA). Among the patients, one died of acute pulmonary edema during the rescue PTCA procedure, one had acute reocclusion after rescue PTCA and died of acute pump failure within 24 h. Guiding wire failed to put through lesions in the other 2 patients. Mass intracoronary thrombosis was present in 5 of 34 patients after primary PTCA despite the restoration of TIMI 3 grade blood flow in the distal segment. The residual thrombosis disappeared after urokinase (500 000-1 500 000 IU) was infused into the culprit coronary.Conclusions Clinical studies have suggested that emergency PTCA is more effective in early reperfusion than that of thrombolysis in AMI. Though emergency PTCA is highly effective, but the initial success rate is lower than that of conventional PTCA with a higher complication and mortality. Thus it should be only steadily introduced into AMI.
