Coronary angioplasty in serious myocardial infarction with device suppported respiration and circulation
█ Original article
Voith László, Nowotta Fanni, Skoda Réka, Merkely Béla, Becker Dávid
Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest
Aim of the study: To analyze of clinical course of pts. with acute myocardial infarction requiring respiratory and/or circulatory device help or hypothermia during primary coronary intervention.
Patients and methods: From 01. 01. 2016 to 31. 12. 2016 we performed 1435 primary percutaneous coronary intervention in 543 acute ST elevation (STEMI) and 892 non-ST elevation (NSTEMI) myocardial infarction. 158 cases (11.0% of patients, 95 male and 63 female) were unconscious after reanimation, having heart failure or being in cardiogenic shock caused by previous infarction or another kind of heart disease, or suffering from other severe disease beside AMI. These patients needed special device support in addition to PPCI, during and after the procedure, intermittent positive pressure breathing (IPPB) 93, intraaortic balloon pump (IABP) 22, IPPB + IABP 23, IPPB and/or IABP + hypothermia 13, IPPB and/or IABP + AV extracorporeal membrane oxygenator (ECMO) 7 in cases. Malignant rhythm disorders requiring direct-current (DC) shock and/or pacemaker treatment have not been separately studied. We analyzed the time intervals from onset of complaint to first ECG and to balloon inflation.
Results: Among STEMI pts the proportion of required special device support was higher than in the NSTEMI group (95 pts. 17.5% vs. 63 pts. 7.2%). Both the time from the beginning of the complaints to the first medical contact (ECG) and to the hospital and the reperfusion (complaint-balloon opening) was longer than average. Within 30 days 63 (39.9%) pts were lost, another 38 (24.0%) by the end of first year. 57 (36.1%) pts. survived more than 1 year.
Discussion: In our opinion, primary PCI should be attempted using the above-mentioned methods in AMI pts in serious condition even if the patients are admitted to the hospital over the 12 hours, which is considered acceptable. We do not have the knowledge to predict the late outcome of the intervention by the time of the admission of an AMI patient.