Background. Primary coronary angioplasty (PTCA) has a beneficial effect on the immediate prognosis for patients
with acute myocardial infarction. Number of information about effects of direct PTCA on the long-term prognosis
are less numerous. The aim of the work was to establish the long-term prognosis for not-selected patients treated by
Methods and Results. The studied group consisted of 279 patients with acute myocardial infarction treated by direct
PTCA in years 1995 to 1999 for the period of 38±12 months. Part of them were out-door patients of our clinic. The
necessary data of the other patients were obtained by a questionnaire and by a telephone contact. 45 (16 %) patients
were lost from the follow up. The mortality rate of the study group was compared with data in the central register
of Czech Republic. Positive angiographic effect of the direct PTCA (residual stenosis <50 % + flow TIMI 3) was
achieved in 90%of patients. 30-daymortality was 6,8%, after excluding patients with cardiogenic shock it decreased
to 3,2 %. 6 patients (2,2 %) had non-fatal infarction within 30 days after the first attack. From 259 patients who
survived the acute infarction phase 24 died during the next period of follow up, 18 (7 %) patients had a relapse of
non-fatal infarction. PTCA of the infarcted artery was done in 15 % of patients, PTCA of another artery in 9 % of
patients. The aorthocoronary bypass was indicated in 6 % of patients. Almost half of relapses occurred during the
first year after the hospitalisation. The risk factors of the death during the follow up were the age >70 years, ejection
fraction <35 %, impairment of 3 or more coronary artery branches, IMin the history, duration of ischeamia >4 hours,
and diabetes mellitus. The total mortality was 11,4 % in the first year, 1,4 % in the second and 3,3 % in the third
year of the follow up.
Conclusions. The beneficial prognostic effect of the direct PTCA on patients with acute infarction carries through
the whole period of follow up. Prognosis of the risk patients remains critical. Next revascularization of the infarcted
artery was in our cohort of patients necessary in 21 % of patients.
primary coronary angioplasty, myorardial infarction, revascularization.