- Carlos Cafri: Department of Cardiology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. cafricar@netvision.net.il
BACKGROUND: Despite the clinical advantages of mechanical reperfusion in the treatment of acute myocardial infarction, widespread use of percutaneous transluminal coronary angioplasty has been limited by a lack of human and institutional resources.
OBJECTIVE: To evaluate the feasibility of a PTCA-based reperfusion strategy for AMI patients selected according to high risk clinical criteria.
METHODS: The study group included 110 patients selected for mechanical reperfusion out of 1,080 AMI patients according to the following criteria: hemodynamic disturbance (40%), large anterior wall MI (54%), contraindication to thrombolysis (15%), previous MI (13%), re-infarction (4.5%), non-diagnostic electrocardiogram (0.9%), and unsuccessful thrombolysis (30%).
RESULTS: Cardiogenic shock was present in 23% of the cases and cardiac arrest with prolonged resuscitation in 8%. The cohort 30 day mortality rate was 15%. The 30 day mortality rate for patients without cardiogenic shock was 6.3%.
CONCLUSIONS: Selection of high risk patients who would benefit most from mechanical reperfusion appears feasible, resulting in low mortality rates when compared with those in the literature. Widespread implementation of well-defined selection criteria should promote better utilization of the limited resources available for primary PTCA.