Systematic coronary stenting after failed thrombolysis in high-risk patients with acute myocardial infarction: procedural results and long-term follow-up
| Autor: | Vincenzi P, Matteo Bottero, Alessandro Fontanelli, Luigi La Vecchia, Luca Favero, Filippo Ottani, Andrea Rubboli, M. Martini |
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| Rok vydání: | 2003 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Anterior Descending Coronary Artery Coronary Angiography Revascularization Internal medicine medicine.artery medicine Humans Thrombolytic Therapy Treatment Failure cardiovascular diseases Myocardial infarction Aged Aged 80 and over business.industry Cardiogenic shock Stent General Medicine Thrombolysis Middle Aged medicine.disease Surgery Right coronary artery Retreatment Cardiology Female Stents Cardiology and Cardiovascular Medicine business TIMI Follow-Up Studies |
| Zdroj: | Coronary Artery Disease. 14:395-400 |
| ISSN: | 0954-6928 |
| DOI: | 10.1097/01.mca.0000085136.16622.33 |
| Popis: | Background Stenting in acute myocardial infarction (AMI) represents a feasible and effective revascularization strategy. However, very little Information is available for patients who receive a stent after failed thrombolysis (so-called 'rescue' stenting). Methods We analysed the procedural results and the 2-year follow-up of all consecutive patients with moderate-to-large AMI treated with rescue stenting in the period 1996-2001. Results The study cohort includes 123 patients (mean age 60 ′12 years, 78% men). Coronary angiography showed multivessel disease in 47% of patients; the infarct-related vessel was the left anterior descending coronary artery in 47%, the right coronary artery in 41%, the left circumflex coronary artery in 9.5% and a saphenous vein graft in 2.5%. Baseline Thrombolysis in Myocardial Infarction (TIMI) flow was grade 0-1 in 65% and grade 2 In 25%. Coronary stenting was attempted in all 123 patients and was successful in 119 out of 123 (96.7%); abciximab was used in 57 out of 123 (46%) and intra-aortic balloon pumping in 35 out of 123 (28%). At the end of the procedure, TIMI 3 flow was obtained in 104 out of 123 (85%) and TIMI 2 flow in 14 out of 123 (11%). There were 10 in-hospital deaths and four late deaths, with a long-term survival of 88.6%. This figure increases to 95.2% if patients presenting with cardiogenic shock are excluded. A new revascularization procedure was performed in 21% of discharged patients (in the target vessel for 12% and in non-target vessels for 9%). Overall, event-free survival at 2 years was 69%. At multi-variate analysis, independent predictors of survival were age (P=0.014) and ejection fraction (P=0.006). Conclusions This report represents one of the first series concerning long-term follow-up after rescue stenting. The main results include a high procedural feasibility, a low late mortality and a target vessel revascularization rate in the range expected with stenting. These data must be viewed as part of the constant effort to optimize revascularization strategies In AMI. |
| Databáze: | OpenAIRE |
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