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The efficacy and limitation of rescue coronary angioplasty for acute myocardial infarction



The efficacy and limitation of rescue coronary angioplasty for acute myocardial infarction



Kokyu to Junkan. Respiration & Circulation 40(4): 389-396



Eighty one patients with acute transmural anterior myocardial infarction admitted our hospital, from January, 1987 to February, 1991, were included in the present study. In 62 cases, reperfusion therapy was performed within 12 hours from the onset of chest pain. Forty nine patients underwent intracoronary thrombolysis, and in 16 patients (group RA) with failed thrombolysis (TIMI .ltoreq. 1) percutaneous transluminal coronary angioplasty (PTCA) was performed as a "rescue" procedure. We studied the efficacy and limitation of rescue PTCA compared with direct PTCA (group DA, n = 13), intracoronary thrombolysis (group CT, n = 33) and conservation therapy without the above interventions (group N, n = 19). Initial reperfusion rate of intracoronary throbmolysis was 53% which was lower than group RA (88%) and group DA (100%) (p < 0.05, p < 0.01, respectively). Residual stenosis of infarct-related artery in the chronic phase (mean 28 .+-. 7 days after initial intervention) in group CT was higher than group RA and group DA (p < 0.01, p < 0.01, respectively). LVEDVI in intervention groups (group CT, group RA, and group DA) were similar and significantly smaller than group N (p < 0.05, p < 0.05, and p < 0.01, respectively). Ejection Fraction (EF) in intervention groups were significantly higher than group N. Regional wall motion of infarcted area in group CT and group DA were significantly better than group N (p < 0.01, p < 0.01, respectively). However, RWM in group RA was not significantly different compared with group N. The incidence of second intervention during hospital days in group CT was 42% (CABG 2, PTCA 12) higher than the other groups. Hospital mortality rate in group N (26%) tended to be higher than the other groups. Thus, DA has advantages in terms of early recanalization, reduction of residual stenosis and preservation of EF. CT seems to preserve EF as well as DA, but there remains the problem of higher residual stenosis, which leads to second interventions. Group RA seems to have a disadvantage in terms of preservation of EF compared with CT, however, it might lessen the hospital mortality rate compared with conservative therapy. This suggests that rescue PTCA should be performed in the case of failed coronary thrombolysis therapy.

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Accession: 007898090

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PMID: 1570429


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