Safety of heparin reversal with protamin and immediate sheath removal after coronary angioplasty.

PURPOSE: To study the safety of giving protamin after coronary angioplasty to reverse heparin for immediate removal of the femoral sheath. MATERIAL AND METHODS: After successful angioplasty, 100 patients were randomized to receive protamin and immediate sheath removal or to the control group with sheath removal after 3 h. Patients were followed for 30 days so that groin complications and coronary events could be compared. After 6 months, target vessel revascularization and death were recorded. RESULTS: The time to mobilization was significantly shorter in the protamin group compared to the control group; 6 versus 19 h. The protamin patients were more satisfied than the control patients, in particular during bed rest after compression. Puncture site complications were one (2%) and two (4%) pseudoaneurysms in the protamin group and the control group, respectively. Early angina and restenosis/reocclusion before 30 days were seen in 4 patients in the protamin group and in 1 in the control group. Adverse incidents between 30 days and 6 months were the same for both groups. CONCLUSION: Protamin reversal improved patient comfort and reduced immobilization time. The cardiac safety concern observed requires the antiplatelet agent clopidogrel to be given before the procedure.

Elective placement of covered stents in native coronary arteries.

PURPOSE: To study the feasibility of placing a polytetrafluoroethylene (PTFE)-covered stent graft into native coronary arteries and assess the complications and the restenosis rate. MATERIAL AND METHODS: Fifty consecutive patients with stable angina pectoris were included and the stent graft was placed into native coronary arteries. Clinical and angiographic follow-up were performed after 6 months. RESULTS: The stent grafts were successfully placed in all patients. The mean reference diameter was 3.3 +/- 0.6 mm. During follow-up the stent grafts occluded in patients after 1, 2 and 2.5 months and one more was occluded at 6 months. Three patients experienced myocardial infarction, 2 Q wave and one non-Q wave. After 6 months 42 (84%) patients had angina NYHA class 0 or 1. Target vessel revascularization was done in 11 cases for restenosis in the graft (n = 4), outside the graft (n = 3) and both (n = 4), giving a restenosis rate of 24%. The total major adverse coronary events at 6 months was 24%. CONCLUSION: The stent graft was deployed with a high success rate. The restenosis rate was not higher than expected for bare stents. However, this study showed that subacute occlusion may occur more frequently and we therefore recommend that ticlopidine or clopidogrel treatment should be prolonged to at least 3 months.

[Long-term follow-up of 100 patients with acute myocardial infarction treated with angioplasty]. / Langtidsresultater etter primaer angioplastikk hos 100 pasienter med akutt hjerteinfarkt.

BACKGROUND: There is little information available on long-term follow up of patients treated with primary angioplasty for acute myocardial infarction. MATERIAL AND METHODS: 100 consecutive patients with acute ST-elevation myocardial infarction and symptoms of less than six hours' duration were treated with primary angioplasty. Clinical examination was performed in 97 patients and exercise stress test in 74 patients 11-37 months (mean 20 months) later. Patients were observed for survival up to 48 months. RESULTS: 24 patients had been rehospitalized, 16 because of chest pain. 77 patients were treated with beta blocker, 83 with statins, and 95 with antithrombotic medication. 84 patients were in NYHA (New York's Heart Association's classification's) class I at follow-up examination. Three patients died. 11 patients had a serious event, reinfarction (n = 3) or need for revascularization (n = 8) during the first 13 months. Total cumulative mortality rates after one and three years were 3% (95% CI 1-8) and 11% (95% CI 6-19). INTERPRETATION: The good initial results in primary angioplasty are maintained in long-term follow-up. This is in accordance with reports from centres abroad.

[Angiographic results of primary angioplasty in acute myocardial infarction]. / Angiografiske resultater av primaer angioplastikk ved akutt hjerteinfarkt.

BACKGROUND: Percutaneous angioplasty is an alternative to thrombolysis to reestablish coronary blood flow in patients with transmural myocardial infarction. At present, this treatment option is not widely accepted in Norway. MATERIAL AND METHODS: From 1996 to 1998, one hundred consecutive patients were treated with angioplasty for acute transmural infarction. The angiography showed one-vessel disease in 55%, two-vessel in 25%, and multivessel in 20%. The infarct related artery was the LAD in 44%, the CX in 14%, the RCA in 41%, and bypass graft in one. 92% had TIMI 0 or 1 flow. Stent was placed in 73%, GPIIb/IIIa was used in 11% and temporary pacemaker placed in 5%. RESULTS: Successful angioplasty was performed in 95%, 3% was not done, and 2% failed. Peripheral stenoses were treated in 15% and stenoses in other arteries in 10%. Complications and events within 24 hours related to the angioplasty were seen in 9%. CONCLUSION: Primary angioplasty for acute myocardial infarction can be done with high primary success, good short-term results and few complications.

[Hundred patients with acute myocardial infarction treated with primary angioplasty]. / Ett hundre pasienter behandlet med primaer angioplastikk ved akutt hjerteinfarkt.

BACKGROUND: Much attention has lately been focused on primary angioplasty in the treatment of acute myocardial infarction. This report describe our results in 100 patients. MATERIAL AND METHODS: 100 consecutive patients with acute ST elevation myocardial infarction and a history of less than six hours were treated with primary angioplasty. The mean time from start of symptoms until establishment of reperfusion of the infarct related artery was 224 minutes; "the door-to-balloon" time was 69 minutes. RESULTS: Angioplasty was successful in 95% of all patients. Mean ejection fraction measured before discharge in 71 patients was 56%. Hospital and 30-days' mortality was 1%. New revascularization was needed in 6%. Average observation period in the coronary care unit was 1.8 days; no patient needed treatment for ventricular arrhythmias after angioplasty. The first 24 hours 24% had symptomatic congestive heart failure, reduced to 11% at hospital discharge on day 6. Acute rehospitalization within the first 30 days was necessary in 7%, but only in 2% for chest pain. INTERPRETATION: Our results are comparable to those of other high volume centres and show well preserved ventricular function and low hospital and 30-days' morbidity and mortality.