[Primary percutaneous transluminal coronary angioplasty in acute myocardial infarction: immediate and short-term results. National experience].

Direct percutaneous transluminal coronary angioplasty (PTCA) in the early phase of acute myocardial infarction (AMI) has till now a relatively limited use, mainly because of logistic problems, in comparison with systemic thrombolysis. The aim of this paper was to discuss the role direct PTCA during AMI, based on the most recent international experience. In brief, the major benefits of direct PTCA are the high percentage of recanalization (90%), optimal recanalization quality, the absence of contraindications in most cases; in patients with cardiogenic shock the mortality is lowered from 80% to 40-45%; absence of haemorrhagic stroke and lower incidence of cardiac ischemic events and urgent coronary artery bypass grafting (CABG) are seen in short-term follow-up. We also present the whole series of 22 Italian centers, all of which has wide experience of PTCA, but not performing it on a routine bases in AMI. It concerns of 721 patients, 389 with single-vessel disease, 198 with double-vessel disease and 105 with triple-vessel disease. Twenty patients presented left main disease and 147 patients were in cardiogenic shock. Palmaz-Schatz stent was implanted in 31 cases; 3 Simpson atherectomy were performed. In 24 cases the PTCA was carried out as a "bridge" to emergency CABG, in the presence of triple-vessel disease. Among the group without cardiogenic shock 400 procedures were direct, 164 were rescue PTCA (within 12 hours). Angiographic success (residual stenosis < or = 50%) was obtained in 92 e 89% of cases respectively. In 147 patients with cardiogenic shock success was 74%. Mortality was 2.8% in patients without shock and 48% in patients with shock.(ABSTRACT TRUNCATED AT 250 WORDS)