Six-month clinical and angiographic follow-up after direct angioplasty for acute myocardial infarction : final results from the primary angioplasty registry

• Published in: Circulation (New York, N.Y.) Vol. 90; no. 1; pp. 156 - 162
• Main Authors: BRODIE, B. R, GRINES, C. L, CALIFF, R. M, O'NEILL, W. W, IVANHOE, R, KNOPF, W, TAYLOR, G, O'KEEFE, J, WEINTRAUB, R. A, BERDAN, L. G, TCHENG, J. E, WOODLIEF, L. H
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.07.1994; American Heart Association, Inc
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Coronary Angiography; Coronary heart disease; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - therapy; Registries; Time Factors; Treatment Outcome; Human; Radiodiagnosis; Angiography; Infarct; Acute; Instrumentation therapy; Cardiovascular disease; Instrumental dilatation; Coronary heart disease; Myocardial disease; Result; Vascular disease; Arteriopathy; Treatment; Follow up study; Myocardium
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.90.1.156

After direct angioplasty in the setting of acute myocardial infarction, patients were followed clinically and angiographically for 6 months at six experienced centers to evaluate outcomes. Of 258 patients with 6-month follow-up after surviving initial hospitalization, 5 (2%) died, 8 (3%) had nonfatal infarctions, 56 (22%) had chest pain, of whom 25 (10%) required hospitalization, and 42 (16%) patients needed repeat angioplasty. Of 203 eligible patients, 154 (76%) had angiographic follow-up. The infarct-related artery remained patent (defined as TIMI 2 or 3 flow) in 87%, while 13% developed reocclusion (TIMI 0 or 1 flow) by 6 months after discharge. Patients with reocclusion were more likely to have adverse events, including 35% with clinically evident reinfarction and 59% requiring repeat angioplasty. The median ejection fraction improvement from acute to follow-up study was 6%, with no improvement in patients with a reoccluded infarct-related artery and an 8% improvement in patients with a patent infarct-related artery. The positive clinical outcomes recorded immediately after direct angioplasty persisted through 6 months of follow-up. Although the incidence of clinical end points was equivalent to or lower than thrombolytic therapy trials, restenosis is a substantial problem. These findings provide evidence beyond the initial hospitalization that direct angioplasty is a reasonable choice for the treatment of acute myocardial infarction.