| Primary angioplasty for the treatment of acute myocardial infarction: experience at two community hospitals without cardiac surgery. | |
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MedLine Citation:
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PMID: 10193725 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We sought to establish the safety and efficacy of primary percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction (AMI) at two community hospitals without on-site cardiac surgery. BACKGROUND: Though randomized studies indicate that primary angioplasty in AMI may result in superior outcomes compared with fibrinolytic therapy, the performance of primary angioplasty at hospitals without cardiac surgery is debated. METHODS: Three experienced operators performed 506 consecutive immediate coronary angiograms with primary angioplasty when appropriate in patients with suspected AMI at two community hospitals without cardiac surgery, following established rigorous program criteria. RESULTS: Clinical high risk predictors (Killip class 3 or 4, age > or = 75 years, anterior AMI, out-of-hospital ventricular fibrillation) and/or angiographic high risk predictors (left main or three-vessel disease or ejection fraction <45%) were present in 69.6%. Angioplasty was performed in 66.2%, with a median time from emergency department presentation to first angiogram of 94 min and a procedural success rate of 94.3%. The in-hospital mortality for the entire study population was 5.3%. Of those without initial cardiogenic shock, the in-hospital mortality was 3.0%. Of 300 patients who were discharged after primary angioplasty, only four died within the first 6 months, with 97.7% follow-up. No patient died or needed emergent aortocoronary bypass surgery because of new myocardial jeopardy caused by a complication of the cardiac catheterization or angioplasty procedure. CONCLUSIONS: Immediate coronary angiography with primary angioplasty when appropriate in patients with AMI can be performed safely and effectively in community hospitals without on-site cardiac surgery when rigorous program criteria are established. |
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Authors:
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T P Wharton; N S McNamara; F A Fedele; M I Jacobs; A R Gladstone; E J Funk |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 33 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 1999 Apr |
Date Detail:
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Created Date: 1999-04-19 Completed Date: 1999-04-19 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1257-65 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiology, Exeter Hospital, New Hampshire, USA. twharton@nh.ultranet.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Angioplasty, Transluminal, Percutaneous Coronary* / mortality Cardiac Surgical Procedures Coronary Angiography Electrocardiography Female Follow-Up Studies Heart Catheterization / mortality Hospitals, Community / statistics & numerical data Humans Male Middle Aged Myocardial Infarction / blood, radiography, therapy* Prognosis Retrospective Studies Safety Survival Rate Treatment Failure |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2000 Jul;36(1):299-303
[PMID:
10898451
]
J Am Coll Cardiol. 1999 Apr;33(5):1266-8 [PMID: 10193726 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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