Circulation, Vol 90, 156-162, Copyright © 1994 by American Heart Association
BR Brodie, CL Grines, R Ivanhoe, W Knopf, G Taylor, J O'Keefe, RA Weintraub, LG Berdan, JE Tcheng and LH Woodlief
BACKGROUND: 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. METHODS AND
RESULTS: 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. CONCLUSIONS:
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.
ARTICLES
Six-month clinical and angiographic follow-up after direct angioplasty for acute myocardial infarction. Final results from the Primary Angioplasty Registry
Department of Medicine, Moses H. Cone Memorial Hospital, Greensboro, NC.
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