Circulation, Vol 88, 2067-2075, Copyright © 1993 by American Heart Association
WD Weaver, PE Litwin and JS Martin
BACKGROUND. In the Myocardial Infarction, Triage, and Intervention (MITI)
registry of acute myocardial infarction, 441 (12%) of 3750 patients had
direct angioplasty as initial treatment. Approximately half (233) were
performed in hospitals with no on-site surgery. METHODS AND RESULTS.
Procedure success rates, use of emergent surgery, and factors influencing
outcome were compared in both angioplasty groups as well as with 653
patients treated with thrombolytic therapy in the same hospitals. There was
no difference in baseline characteristics between patient groups treated by
angioplasty in the two types of hospitals. Patency was established in 88%
of patients. Only 1.4% underwent emergent surgery. Overall, survival was
93% but was significantly worse after a failed procedure in all ECG and
hemodynamic subsets as well as in those with prior bypass surgery. In a
multivariate analysis, age, initial heart rate, blood pressure, and prior
bypass surgery but not type of hospital were predictive of survival.
Survival rates were similar, but there tended to be fewer strokes (0.6%
versus 2.1%, P = .12), shorter hospital stays (7.0 versus 8.1 days, P <
.001), and less recurrent ischemia (20% versus 30%, P = .009) in patients
treated by angioplasty compared with thrombolysis. Readmission and
reinfarction rates were similar for both treatments. CONCLUSIONS.
Observations from this community registry suggest that mortality after
direct angioplasty is low and the use of emergent surgery is infrequent.
Outcome in this registry study was dependent on initial hemodynamic
findings and infarct location but not on the presence of on-site surgery.
Compared with thrombolytic therapy, the incidence of complications was the
same or lower, but this needs confirmation in randomized trials.
ARTICLES
Use of direct angioplasty for treatment of patients with acute myocardial infarction in hospitals with and without on-site cardiac surgery. The Myocardial Infarction, Triage, and Intervention Project Investigators
Division of Cardiology, University of Washington, Seattle.
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