Angioplastía coronaria primaria como tratamiento de elección en las primeras 6 horas del infarto de miocardio / Primary coronary angioplasty as elective treatment in the 6 first hours of acute myocardial infarction

RESUMO

Primary coronary angioplasty as treatment of acute myocardial infarction preserves more myocardium and has a lower mortality than trombolysis. Aiming to assess the feasibility of its use in Chile, were studied 64 patients aged 59ñ2 years old, 27 with and anterior wall and 37 with an infero-lateral wall acute myocardial infarction of 118ñ62 min of evolution. Coronary angiography, performed 98ñ47 min after diagnosis, showed non significant disease in one, one vessel disease in 26 (40 percent), 2 vessel disease in 17 (27 percent) and 3 vessel disease in 20 (40 percent), circumflex in 9 (14 percent), right in 27 (42 percent), a saphenous bridge in 1 and left main disease in 1 patient. In 1 patient with an obstruction over 50 percent and in 2 patients with left main disease, angioplasty was not attempted. The procedure was succesful (defined as a residual lesion of less than 50 percent) in 56 of 61 patients (92 percent) and failed in 4. One patient was re-perfused with intracoronary streptokinase. The delay in reperfusion was lower during working than non-working hours (89ñ48 vs 113ñ39 min). Four patients (6 percent) died during hospitalization, two had a reinfarction, 2 had a new vessel occlusion and 3 had a spontaneous ischemia. Eleven patients were operated during hospitalization and in 2 this was an emergency procedure. After 1993, mortality was lower (1 of 55 patients) than before (3 of 9). It is concluded that early coronary angioplasty in acute myocardial infarction is feasible in Chile, with a high degree of success