Emergency percutaneous transluminal coronary angioplasty without thrombolysis as initial therapy in acute myocardial infarction.

Thrombolytic treatment in acute myocardial infarction does not influence the atheromatous coronary lesions which form the basis of thrombosis. The remaining stenosis may be responsible for recurrent ischemic symptoms or reinfarction. Percutaneous transluminal coronary angioplasty without thrombolysis was attempted in 19 anterior and 24 inferior wall acute infarctions, within the first 4 hours from the onset of symptoms. The aim was to achieve optimal myocardial revascularization and prevent reocclusion of the infarct-related vessel. Significant stenosis or complete occlusion was found in only one major coronary artery in 25 patients, in two arteries in 7 patients and in three in 11 patients. Angioplasty was only applied to the vessel supplying the infarcted muscle. Recanalization was achieved from 14 to 50 minutes (mean 23) from the start of catheterization in 95% (41/43 cases). Two of the patients died in cardiogenic shock. Four patients died between days 5 to 15 of hospitalization. There were no other deaths. Thirty (81%) of the 37 survivors remained asymptomatic, 3 required bypass surgery for recurrent angina. Follow-up hemodynamic studies were done on average 2.5 months after angioplasty, and showed that, in 78%, the dilated coronary artery remained patent. Restenosis was found in five patients, and was successfully dealt with using angioplasty in three cases. In those patients with improved segmental wall motion, the global left ventricular function also increased. This applied to both anterior and inferior infarcts. Our results suggest that immediate coronary angioplasty in acute impending myocardial infarction is effective and avoids the need for prior thrombolytic therapy.