Coronary Stent
Implantation in the Reperfusion Treatment Strategy of the Acute Myocardial Infarction
Kala P., Poloczek M., Boček O., Jeřábek P., Neugebauer P., Kosová J.
Interní kardiologická klinika FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Bořivoj Semrád, CSc. |
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Summary:
Background: Primary coronary angioplasty was accepted as a method of choice in the reperfusion
treatingstr ategy of the ST elevation acute myocardial infarction. Since 1995, when the very good
results of the stent implantation in patients with acute myocardial infarction were published,
there has been a general trend to more stenting also in the Czech Republic. Aim: The analysis of
the effectivity and safety of the coronary stent implantation in acute myocardial infarction.
Methods: Prospective analysis of the patients with ST elevation acute myocardial infarction treated
with primary coronary angioplasty with one coronary stent implantation at least in the
period I/2000 - XII/2000. Results: In the above mentioned period the authors carried out the total
of 116 primary coronary angioplasties in 116 patients with ST elevation acute myocardial infarction.
Balloon angioplasty only was done in 27 patients (23.3 %) only, at least one stent was implanted
in 89 patients (76.7 %). The average procedure time was 58 ± 27.2 mins, fluoroscopy 10.6 ± 6.6 mins,
sciagraphy 1,8 ± 0,7 mins. Primary angiographical result was optimal in 82 cases (92.2 %) with
achievingTIMI flow 3, in 5 cases (5.6 %) there was slower perfusion of the infarcted artery observed
with TIMI flow 2 and in 2 cases (2.2 %) the authors were unsuccessful with final TIMI flow 0 -
1. Coronary stents were implanted in 13 cases (13.8 %) without predilatation as so called “direct
stenting”, in 19 cases (20.2 %) the planned or “elective” stenting was done, in 47 cases (50 %) the
suboptimal result after balloon angioplasty only was the reason for stent implantation and in 15
cases (16 %) it was rescue “bail-out” stenting in complications of the balloon angioplasty only or if
the result after balloon angioplasty was unsuccessful. Primary angiographical success of the
stented lesion was 100 % and in 14 cases (15.7 %) the abciximab as a representative of IIb/IIIa
platelet blockers was given. Periprocedural complications (up-to 24 hours after the procedure) in
the stented group of patients occurred in 2 cases (2.2 %), further serious in-hospital cardiovascular
complications occurred in another 4 cases (4.4 %). The total of 5 patients (5.5 %) died in the
hospital, out of which 4 patients (4.4 %) died due to the primary cardiogennic shock and 1 patient
(1.1 %) admitted in pulmonary oedema died due to the heart failure progression. Excluding patients
primary in cardiogennic shock the in-hospital mortality was 1.2 % only. Hospital mortality in the group of patients treated with primary balloon angioplasty only was 3.7% (1 patient). Conclusion:
At present the coronary artery stentingis safe and highly effective method in acute myocardial
infarction treatment.
Key words:
Acute myocardial infarction - Coronary stent - Primary coronary angioplasty
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