CATHETERIZATION LABORATORY EVENTS AND HOSPITAL OUTCOME WITH DIRECT ANGIOPLASTY FOR ACUTE MYOCARDIAL-INFARCTION

To assess the safety of direct infarct angioplasty without antecedent thrombolytic therapy, catheterization laboratory and hospital events were assessed in consecutively treated patients with infarctions involving the left anterior descending (n = 100 patients), right (n = 100), and circumflex (n = 50) coronary arteries. The groups of patients were similar for age (left anterior descending coronary artery, 59 years; right coronary artery, 58 years; circumflex coronary artery, 62 years), patients with multivessel disease (left anterior descending coronary artery, 55%; right coronary artery, 55%; circumflex coronary artery, 64%), and patients with initial grade 0/1 antegrade flow (left anterior descending coronary artery, 79%; right coronary artery, 84%; circumflex coronary artery, 90%). Cardiogenic shock was present in eight patients with infarction of the left anterior descending coronary artery, four with infarction of the right coronary artery, and four with infarction of the circumflex coronary artery. Major catheterization laboratory events (cardioversion, cardiopulmonary resuscitation, dopamine or intra-aortic balloon pump support for hypotension, and urgent surgery) occurred in 10 patients with infarction of the left anterior descending coronary artery, eight with infarction of the right coronary artery, and four with infarction of the circumflex coronary artery (16 of 16 shock and six of 234 nonshock patients, p < 0.001). There was one in-laboratory death (shock patient with infarction of the left anterior descending coronary artery). Minor in-laboratory events (brief bolus atropine or pressor, and temporary pacer) occurred in an additional six patients with infarction of the left anterior descending coronary artery, 27 with infarction of the right coronary artery, and six with infarction of the circumflex coronary artery (p < 0.001 for right coronary artery). Initial flow was grade 0/1 in 60 of 61 patients with events. Procedural success (alive, ≤ 40% stenosis, no surgery) was achieved in 96% of patients with infarction of the left anterior descending coronary artery, 98% of patients with infarction of the right coronary artery, and 90% of patients with infarction of the circumflex coronary artery (p = NS). Predischarge angiography demonstrated sustained arterial patency in 95% of 65 patients with infarction of the left anterior descending coronary artery, 90% of 62 with infarction of the right coronary artery, and 81% of 26 with infarction of the circumflex coronary artery. Hospital survival was 93% for patients with infarction of the left anterior descending coronary artery, 96% for those with infarction of the right coronary artery, and 94% for those with infarction of the circumflex coronary artery (p = NS). Thus, major catheterization laboratory events are infrequent during direct infarct angioplasty. Although minor catheterization laboratory events are common, and should be anticipated with right coronary artery infarcts, direct infarct angioplasty results in excellent arterial patency and hospital survival.