Purpose: To describe the feasability, technical success, early results and mid-term follow-up of coronary stenting (CS) in patients (pts) with acute myocardial infarction (AMI). Methods: Thirty pts (mean age 60 yrs, range 38-83 yrs; 19 males) underwent coronary angioplasty (PTCA) and CS for AMI at our institution from Jan 1, 1994 to April 30, 1996. They represent 60% of all pts treated with PTCA for AMI. The procedure was "rescue" in 6 and "primary" in 24. The infarct-related vessel was: LAD (20), RCA (7), LCX (2), vein graft to LAD (1). Multivessel disease (MVD) was present in 8 pts. Results: A total of 33 Palmaz-Schatz stents and 1 Wiktor stent were implanted. Seven pts were in cardiogenic shock; 11 were under intra-aortic balloon pumping (IABP). Mean time to reperfusion was 150 min (range 30-600). The indication for CS was: reocclusion (17); suboptimal result (i.e. TIMI flow <3, residual thrombus and/or stenosis) (13). Angiographic success (residual stenosis = 0% and TIMI 3 flow) was obtained in 29 pts (97%); 1 pt died after CS of a single-remaining RCA because of massive distal embolization. Three pts had no enzyme elevation. In the other 26, CK-MB peak was 220 U (range 15-1477). There were 4 in-hospital deaths: subacute thrombosis (1), aortic rupture following prolonged IABP (1); 2 intractable shock (2). Overall mortality (17%) affected pts with MVD (5/5) and cardiogenic shock (4/5). There were 2 early stent thrombosis successfully treated with repeated PTCA and CS. After a follow-up of 9 months (range 1-26), no cardiac events were observed. Conclusions: CS in the setting of AMI is technically feasible and provides excellent angiographic results. Early success is counterbalanced by a relatively high mortality (related to severe cardiac dysfunction) and incidence of subacute thrombosis. Clinical implications: Our initial experience suggests that stenting represents an effective treatment to obtain reperfusion in AMI. Further improvement in medical management and procedural strategy may contribute to decrease the incidence of subacute thrombosis.
|Issue number||4 SUPPL.|
|Publication status||Published - Oct 1996|
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine