Document Detail


Results of primary angioplasty for acute myocardial infarction in patients with multivessel coronary artery disease.
MedLine Citation:
PMID:  2229753     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The influence of multivessel coronary artery disease on the outcome of reperfusion therapy for myocardial infarction has not been fully characterized. Direct coronary angioplasty without antecedent thrombolytic therapy was performed during evolving myocardial infarction in 285 patients with multivessel coronary artery disease at 5.2 +/- 4.2 h after the onset of chest pain. Two vessel disease was present in 163 patients (57%) and three vessel disease in 122 (43%). An anterior infarct was present in 123 patients (43%), cardiogenic shock in 33 (12%) and age greater than or equal to 70 years in 59 (21%). Angioplasty of the infarct-related vessel was successful in 256 patients (90%), including 92% with two vessel and 88% with three vessel disease (p = NS). Emergency bypass surgery was needed in six patients (2%). In-hospital death occurred in 33 patients (12%), including 13 with two vessel and 20 with three vessel disease (p less than 0.05). The mortality rate was only 4% in the subgroup of 101 patients who met entry criteria for thrombolytic trials. The in-hospital mortality rate was 45% in patients in shock and 7% in patients not in shock (p less than 0.01). Logistic regression analysis identified shock and age greater than or equal to 70 years as independently associated with in-hospital death. In 135 patients who underwent predischarge left ventriculography, global ejection fraction increased from 50% to 57% (p less than 0.001) and regional wall motion in the infarct zone improved in 59% of patients. Follow-up data were available in 251 patients (99%) at a mean of 35 +/- 19 months.(ABSTRACT TRUNCATED AT 250 WORDS)
Authors:
J K Kahn; B D Rutherford; D R McConahay; W L Johnson; L V Giorgi; T M Shimshak; R Ligon; G O Hartzler
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  16     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1990 Nov 
Date Detail:
Created Date:  1990-12-11     Completed Date:  1990-12-11     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1089-96     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Consultants, Inc., Mid America Heart Institute, St. Luke's Hospital, Kansas City, Missouri 64111.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Artery Bypass
Coronary Disease / mortality,  therapy*
Coronary Vessels / pathology
Emergencies
Female
Humans
Male
Middle Aged
Myocardial Infarction / mortality,  therapy*
Myocardial Reperfusion / methods
Regression Analysis
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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