Direct Percutaneous Transluminal Coronary Angioplasty for Acute Myocardial Infarction

We examined the utility of direct percutaneous transluminal coronary angioplasty-direct PTCA-in patients with acute myocardial infarction. The subjects were 124 patients with acute myocardial infarction, hospitalized in our facility, who underwent direct PTCA (mean age : 63. 2 years old). Primary success was achieved in 91.1%, and the residual coronary luminal narrowing at sites of dilatation was 35.6±23.3%. Causes of failed PTCA were : inability to pass the guide wire through the target lesion in 5 patients, inability to advance the dilatation catheter in 2, insufficient dilatation in 2, coronary dissection in 1, and difficulty in advancing the guiding catheter into a tortuous aorta in 1. Acute coronary occlusion was found in 6 patients as an early complication related to direct PTCA, but was successfully treated in 5 patients by repeat PTCA. The in-hospital mortality rate was low : 5 patients with cardiac death (mortality rate : 4.0%), of which 4 showed cardiogenic shock. Two weeks after occurrence, coronary angiography and left ventriculography could be performed in 105 of 113 patients who had undergone successful direct PTCA. The patency rate of the infarct-related artery was 93.3%, and the ejection fraction from the left ventricle was 56.1±13.1%. It was concluded that direct PTCA was a useful means of acute myocardial infarction.