Intracoronary thrombolysis for high risk patients with acute myocardial infarction

: Fifty-four patients with acute myocardial infarction (AMI) were treated by percutaneous transluminal coronary recanalization (PTCR) within six hours after onset of symptoms or at the time of emergency coronary angiography. Of these, six patients had neither good collaterals nor recanalization, and followed by mechanical failure due to rupture of the left ventricular free wall or interventricular septum in five patients despite antihypertensive therapy. In the remaining 48 patients with good collaterals or recanalization, mechanical failure was statistically infrequent and occurred in only two patients (p less than 0.001). Ninety-four patients treated by PTCR were assessed in terms of mortality, cause of death and their hemodynamic findings. Cardiac deaths occurred in nine patients (9.6%); mechanical failure, in four; and cardiogenic shock due to the occlusion of the left main trunk, in five. Cardiac death was more frequently encountered in the era of the initial stage of PTCR (six of 53 cases: 11.3%) and the main cause was mechanical failure (four of six cases). On the other hand, cardiac death in recent years of PTCR was less (three of 41 cases: 7.3%), and all three had pump failure due to the occlusion of the left main trunk. Risk of mechanical failure was successfully resolved using intra-aortic balloon pumping and beta-blocker in addition to antihypertensive therapy. At the present time, PTCR and other supplementary therapy mentioned above reduced the mortality from mechanical failure and cardiogenic shock, but occlusion of the left main trunk remains an important cause of death in patients with AMI.