Objective: To approach the efficacy of emergency percutaneous transluminal coronary angioplasty (PTCA) in Chinese patients with acute myocardial infarction (MI) complicated by cardiogenic shock.
Methods: Twelve patients with cardiogenic shock treated by emergency PTCA in this institution from January 1990 to May 1994 were retrospectively reviewed. There were anterio-lateral MI in 4 cases, inferio-posterial MI in 7, anterial and inferial MI in I, of which triple vessel disease in 4 cases, double vessel disease in 6, single vessel disease in I and left main coronary artery (LM) disease in 1. PTCA was performed under assistance of IABP in 7 cases and of centrifugal pump in 1. Only infarct-related Coronary artery (IRCA) was dilated during acute phase. Direct PTCA was done in 7 cases and rescue PTCA after failure of thrombolytic therapy in 5.
Results: PTCA was successful in 11 (91.7%) of the 12 cases, in 1 case with failure of PTCA the IRCA was reperfused by intracoronary thrombolytic therapy. Cardiogenic shock was reverted in 7 (63.6%) of the 11 cases reperfused by PTCA, among whom 6 (54.5%) survived. Four died of irreversible shock after 3 hours-9 days and 1 case with reversed shock died of cardiac rupture after 4 days. During a period of 13-55 months follow-up, long-term survivals were obtained in 4 cases.
Conclusions: Emergency PTCA can achieve a high success rate and significantly decrease the mortality rate to less than 50% in Chinese patients with acute MI complicated with cardiogenic shock. The patients tolerate the PTCA procedure very well under the assistance of intra-aortic balloon counterpulsation (IABP) even in very severe condition.