Info

Infarct size

Composite endpoint

Fig. 13. Six-month outcome in the STOP AMI trial. Data from ref. 13.

Table 3

Criteria for Low Risk Classification in the PAMI II Study3

Age < 70 yr EF > 45% 1 or 2 vessel disease Native culprit artery Successful PTCA

No (recurrence of) ventricular arrhythmia aAdapted from ref. 54.

MI, including fibrinolytic-therapy-ineligible patients. Of the 908 patients entered in the study, emergency angiography identified 437 and 471 patients at high and low risk, respectively, for in-hospital death. The criteria for assignment to the low-risk status are shown in Table 3. The in-hospital event rates are shown in Fig. 14. Importantly, there were no death or reinfarction in the week following discharge in low-risk patients randomized to early discharge without functional testing. Early angiography and angioplasty indeed identified a low-risk group of patients with mortality comparable to that of elective angioplasty patients. IABP did not confer a significant advantage in death, reinfarction, or reocclusion in the high-risk patients. Nevertheless, IABP was associated with a significantly lower need for repeat angiography and repeat PTCA of the infarct-artery in these patients.

Although the immediate results of primary angioplasty are quite satisfactory, the rate of restenosis and recurrent clinical events remained disappointing. Nakagawa et al. studied survivors of acute MI treated with primary balloon angioplasty from the angiographic standpoint (55). The cumulative rates of restenosis and reocclusion at 3 wk, 4 mo, and 1 yr were 8.8 and 12%, 29 and 14%, 33 and 14%, respectively. Thus, restenosis was very prevalent in this cohort, while reocclusion was less frequent and tended to occur early in the follow-up period (Fig. 15).

ADVANCES IN PRIMARY ANGIOPLASTY: DEVICES AND PHARMACOLOGY

Fig. 14. (A) In-hospital event rates for high risk patients treated with (black bars) or without IABP (white bars) in the PAMI II study. (B) In-hospital event rates for low risk patients randomized to intensive care (black bars) or stepdown (white bars) care in the PAMI II study.(Adapted from ref. 54.)

Fig. 14. (A) In-hospital event rates for high risk patients treated with (black bars) or without IABP (white bars) in the PAMI II study. (B) In-hospital event rates for low risk patients randomized to intensive care (black bars) or stepdown (white bars) care in the PAMI II study.(Adapted from ref. 54.)

Fig. 15. Incidence of angiographic restenosis and reocclusion in primary angioplasty patients. Reproduced with permission from ref. 55.

Table 4

Randomized Trials of Coronary Stenting in Acute MI

Table 4

Randomized Trials of Coronary Stenting in Acute MI

Study (reference)

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