Coronary angioplasty for acute myocardial infarction in a hospital without cardiac surgery.

We evaluated, retrospectively, the hospital records of 100 consecutive patients with acute myocardial infarction who underwent emergency coronary angiography and percutaneous transluminal coronary angioplasty between January 1984 and August 1990. Intracoronary streptokinase (250,000 to 1 million units) was administered to 46 of these patients. Reperfusion was achieved in 82 patients, 8 of whom died in the hospital within 30 days. Angioplasty failed in 18 patients. Six were managed medically and survived, 7 survived emergency coronary bypass surgery at a nearby facility, and 5 died. The overall mortality rate was 13%. No facilities for open-heart surgery were available at our hospital; however, surgical back-up was available at another hospital, 0.5 miles away. No death was related to the transfer of a patient or to the unavailability of an in-house cardiac surgery facility. The American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures has written guidelines for cardiac surgical back-up for percutaneous transluminal coronary angioplasty. These guidelines strongly recommended that an experienced cardiovascular surgical team be available for emergency surgery in the institution as a back-up for all angioplasty procedures. Our study shows, however, that with careful case selection, emergency angioplasty for acute myocardial infarction can be performed safely with good results in a setting without on-site cardiac surgery facilities.