778-6 Timing, Mode and Predictors of Death After Direct Angioplasty for Acute Myocardial Infarction

Abstract

The timing and mechanisms of early (30 day) mortality in 330 consecutive patients (pts) treated with direct angioplasty less than 12 hours after onset of myocardial infarction (MI) without antecedent thrombolysis were studied. There were 38 deaths (11,5% of pts). with a majority being due to cardiogenic shock (76%). Other causes included acute closure (11%). death after emergency bypass surgery (5%), ventricular arrhythmias (5%), and respiratory failure (3%1. Therefore 37 of 38 deaths (97%) were cardiac. No deaths from stroke or cardiac rupture were seen, in contrast to trials of thrombolytic agents, Most deaths were seen early, with 47% occurring within 1 day, 35% from days 2–7, and 18% from days 8–30, Deaths from cardiogenic shock was the most common cause of death throughout this period: 83% of deaths in days 0–3, 88% of deaths in days 4–6, and 43% of deaths in days 8–30. The pts who died were significantly older (69 ± 11 vs. 61 ± 11 years, p < 0,0001), had more frequent direct angioplasty failure 124% vs 7%, P < 0.05), reduced ejection fraction (31 ± 17% vs 44 ± 14%, P < 0.0001), more multivessel disease (74% vs 54%, p < 0.05), and more anterior infarcts (74% vs 42%, p < 0.0005) than survivors, Gender, prior MI, and prior bypass surgery did not effect mortality. Cardiogenic shock is the most common cause of early death after direct angioplasty for MI. Pts with one or more risk factors for early death may benefit from additional myocardial salvage or revascularization efforts in the early post-infarct period. Causes of death after direct angioplasty appear to be different than those described after lytic therapy for MI. Specifically, myocardial rupture and intracranial hemorrhage were not causes of death in this study population.