Direct percutaneous transluminal angioplasty without thrombolysis as primary treatment for myocardial infarction in a community hospital

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Abstract
Out of 2224 patients who presented to a community hospital with acute myocardial infarction, 54 hemodynamically stable patients were treated by direct angioplasty without thrombolysis over a 5-year period. Immediate angiographic success was 92%, in-hospital mortality was 2%, and long-term cardiac mortality at 21 .+-. 19 months was 4%. Long-term follow-up revealed an excellent prognosis. Most patients with single-vessel disease did not require further intervention, patients with two-vessel disease were often treated with follow-up angioplasty of the noninfarct vessel, and patients with triple-vessel disease were referred for coronary artery bypass surgery unless there was a negative stress test. Patients who refused coronary artery bypass surgery had a high mortality. These results compare favorably to larger series reported by major referral centers that routinely perform direct percutaneous transluminal coronary angioplasty (PTCA) on all patients presenting with an acute myocardial infarction. We conclude that, in a community hospital, direct PTCA without thrombolysis as primary treatment for myocardial infarction is a safe and effective method of achieving rapid reperfusion of the infarct vessel. In addition, initial patency is superior to that reported with thrombolysis, and one-year mortality is extremely low. Therefore, the efficacy of direct PTCA without thrombolysis as primary treatment in patients presenting with an acute myocardial infarction should be compared with intravenous thrombolysis in a large multicenter trial.