Acute myocardial infarction: Patient selection for reperfusion with coronary angioplasty

Carlos Cafri, Eugene Crystal, Sergio Kobal, Jean Marc Weinstein, Harel Gilutz, Reuben Ilia

    Research output: Contribution to journalArticlepeer-review

    Abstract

    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 thrombolysls (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.

    Original languageEnglish
    Pages (from-to)241-244
    Number of pages4
    JournalIsrael Medical Association Journal
    Volume5
    Issue number4
    StatePublished - 1 Apr 2003

    Keywords

    • Acute myocardial infarction
    • Coronary angioplasty
    • Primary percutaneous transluminal coronary angioplasty
    • Reperfusion

    ASJC Scopus subject areas

    • General Medicine

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