Progress in Cardiology
Infarct artery reocclusion after primary angioplasty, stent placement, and thrombolytic therapy for acute myocardial infarction

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Abstract

Background The benefits of thrombolytic therapy for acute myocardial infarction (AMI) are limited by reocclusion of the infarct-related artery, which occurs in 25% to 30% of patients after successful reperfusion. The frequency of reocclusion after balloon angioplasty and stenting in this setting is less well documented. The aim of this study was to analyze the frequency and timing of reocclusion after percutaneous transluminal coronary angioplasty (PTCA) and stent placement during AMI from all available studies compared with previously published reocclusion rates after thrombolysis. Methods and Results The previously published thrombolysis data included 4231 patients in 19 studies with ≥75 patients. Only PTCA studies with ≥50 patients and stent studies with ≥30 patients, in which routine angiographic follow-up was obtained in ≥60% of patients, were included. Ten PTCA studies with a total of 1943 patients were analyzed, with follow-up angiography in 1391 (72%). Reocclusion rates ranged from 5% to 16.7%. The stent studies included 698 patients from 7 studies, with follow-up angiography in 92%. Reocclusion rates ranged from 0% to 6%. With the use of logistic regression analysis with allowance for overdispersion, there was a significantly lower rate of reocclusion after PTCA (odds ratio, 0.38; confidence interval, 0.24 to 0.57; P <.0001) and stent placement (odds ratio, 0.11; confidence interval, 0.05 to 0.22; P <.0001) compared with thrombolysis. Reocclusion after stent placement was lower than after PTCA (odds ratio, 0.28; confidence interval, 0.13 to 0.6; P <.0001). Conclusions Reocclusion after PTCA and stent placement during AMI is less frequent than after thrombolysis. This may contribute to the superior outcome of patients treated with PTCA and stent placement in this setting. (Am Heart J 2001;141: 704-10.)

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%.

. Reocclusion rates after balloon angioplasty for AMI

Author/year of publicationPatients (n)Procedural success (%)Patients undergoing follow-up angiography (n)Reocclusion (%)Time to angiography (mean)
De Boer et al12 (1995)14097130592 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]

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