Gelijke resultaten van primaire percutane transluminale coronaire angioplastiek bij direct en indirect verwezen patiënten met acuut myocardinfarct

Description of the results of primary percutaneous transluminal coronary angioplasty (PTCA) in the management of acute myocardial infarction.

Design

Prospective, descriptive.

Method

Data were collected on case record forms of consecutive patients with an acute myocardial infarction who in 1990-1997 were referred for primary PTCA directly to Hospital De Weezenlanden, Zwolle, the Netherlands, or indirectly from another hospital.

Results

Patients to be considered numbered 1296, 1004 males and 292 females, with a mean age of 60 years. The number of patients increased markedly in the course of the study period. Patients referred by another hospital more often had anterior wall myocardial infarction (73 as against 42) or cardiogenic shock (10 as against 7). A total of 1187 (92) patients underwent primary PTCA, 46 (4) an emergency bypass operation and 63 (5) only pharmacotherapy. Transportation from a referring hospital lasted a median of 70 minutes, but for patients in De Weezenlanden it took 15 minutes more to arrive in the hospital, and 30 minutes more between admission and PTCA. The mortality within 30 days was low in both groups (referred from another hospital: 7; transported immediately to De Weezenlanden: 5); the same was true of the risk of a recurrent infarction within 30 days (2 and 1). Cardiogenic shock was associated with higher mortality (32 and 38).

Conclusion

Primary PTCA as therapy for acute myocardial infarction can be applied in routine clinical practice.