Früh- und Langzeitergebnisse der direkten PTCA bei Patienten mit akutem Myokardinfarkt (In-hospital results and longterm follow-up of direct PTCA in patients with acute myocardial infarction)

Autor: R. Voss, W. Waas, B Waldecker, Harald Tillmanns, Werner Haberbosch
Rok vydání: 1997
Předmět:
Zdroj: Zeitschrift f�r Kardiologie. 86:703-711
ISSN: 1435-1285
0300-5860
Popis: A review of the literature suggests that direct PTCA for acute myocardial infarction is indicated and feasible in 90-95% of unselected, consecutive patients; direct PTCA is reported to be successful in > 90% of procedures. This results in a hospital mortality of 3-7% for unselected patients and a 4% re-infarction rate. A recent meta-analysis of direct PTCA vs i.v. thrombolysis in patients with acute infarction demonstrates a lower mortality after PTCA (4.4% vs 6.5%, p = 0.02) as well as lower mortality/re-infarction rate (7.2% vs 11.9%, p < 0.001). Mortality in the 1st year after discharge is < 5% with about half of the fatalities being due to cardiac causes. Patients presenting with or developing cardiogenic shock in the acute infarct phase experience a 20-50% acute mortality. Mortality rests at < 10% in these patients in the first year after discharge. In conclusion, (1) direct PTCA is feasible without additional risks in patients with acute myocardial infarction, (2) angiographic and clinical success rates of direct PTCA are favorable and superior to i.v. thrombolysis in the hands of expert operators, and (3) referral to an institution providing the option of immediate, direct PTCA must be considered in the patient with acute infarction but contraindication(s) to i.v. thrombolysis.
Databáze: OpenAIRE
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