Progress in CardiologyInfarct artery reocclusion after primary angioplasty, stent placement, and thrombolytic therapy for acute myocardial infarction☆
Section snippets
Methods
A search was performed with the MEDLINE database (from January 1966 through December 1998, in the English language) with the key words reocclusion, myocardial infarction, and either (1) angioplasty or (2) stent. The scientific session abstracts published in Circulation (1996 to 1997) and the Journal of the American College of Cardiology (1996 to 1998) were also searched. Studies were included if the entry criteria required symptoms of AMI that persisted for >30 minutes, accompanied by ST
Primary PTCA
Between 1987 and 1998, 10 studies were found that met the above inclusion criteria. Table II12, 13, 14, 15, 16, 17, 18, 19, 20, 21 summarizes these studies; 1943 patients were included, with initial success rates of PTCA ranging between 80% to 97%.Author/year of publication Patients (n) Procedural success (%) Patients undergoing follow-up angiography (n) Reocclusion (%) Time to angiography (mean) De Boer et al12 (1995) 140 97 130 5 92 d Nakagawa et al13
Discussion
The widespread use of thrombolytic therapy in AMI has substantially reduced both early and late mortality rates.1 The main benefit of thrombolytic therapy results from the rapid achievement of coronary patency and limitation of infarct size. However, a drawback of thrombolytic therapy is the high rate of reocclusion of the infarct-related artery over time,5, 6 reducing the benefits of early reperfusion.3 We have demonstrated a decrease in the overall incidence of reocclusion after PTCA and
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Reprint requests: Peter B. Berger, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905. Email: [email protected]