-Value of activated blood coagulation time in monitoring anticoagulation during coronary angioplasty-. / Der Stellenwert der aktivierten Gerinnungszeit (ACT) in der Uberwachung der Antikoagulation bei Koronarangioplastie.

Accurate heparin anticoagulation assessment is important to prevent complications (hemorrhage, thrombotic coronary occlusion) during and after coronary angioplasty (PTCA). Paired ACT-, aPTT- and prothrombin time (PT) measurements have not been studied after PTCA using a high dose heparin management. For that reason we analyzed in 150 consecutive patients (115 m., 35 f., 61 +/- 10 y.) immediately after PTCA and at the time of arterial sheath removal aPTT-(Neothromtin, Behring), PT- (Thromborel S, Behring) and ACT-(HR-ACT, HemoTec) values after application of 20,000 U of heparin (5,000 U intravenous, 15,000 U intracoronary) followed by a heparin-infusion (15,000-25,000 U/24 h). Immediately after PTCA in all patients a aPTT above the upper limit of >180 s was found. The average postprocedural ACT was 330 +/- 82 s. Only 9 patients showed an ACT below 200 s. All coronary reocclusions (n = 3) immediately after PTCA occurred in this group. Arterial sheaths were removed 13 +/- 3 h after PTCA. The incidence of minor peripheral bleeding complications at that time was 21% and was related to the anticoagulation level. Major bleeding complications requiring transfusion were noted in only one case. Our findings suggest that after high dose heparinization for PTCA the ACT test provides a reliable and broad range for the assessment of heparin anticoagulation. In contrast to the aPTT the ACT is ideally suited to determine the dosage of heparin infusion and the time of arterial sheath removal after PTCA. ACT measurements are superior to aPTT measurements in heparin anticoagulation assessment during and direct after PTCA.

Primary mechanical recanalization of occluded coronary arteries without prior thrombolytic therapy in patients with acute myocardial infarction. A single-center study reporting acute results and complications.

This study reports on 261 consecutive patients admitted to the Wuppertal Heart Center with acute myocardial infarction (186 men, 75 women; average age: 58.2 +/- 11.6 years) and then treated by primary coronary artery angioplasty. Sixteen patients with cardiogenic shock were included, as well as 42 patients aged > or = 70 years, 51 patients with contraindications for thrombolysis, and 13 patients with prior coronary bypass surgery. All patients were treated between 12/89 to 6/94 and had not received prior thrombolytic therapy. The period of time between onset of pain and revascularization of the infarct-related vessel averaged 224 +/- 205 min. Half of the patients had multi-vessel disease, and about 31% had had a prior myocardial infarction. 100 patients suffered from an anterior wall infarction, 109 patients from an inferior wall infarction, 50 patients from a posterolateral infarction, and in two cases the infarct localization could not be determined from the ECG. Mean biplane left ventricular ejection fraction averaged 56 +/- 13%, left ventricular end-diastolic pressure 20 +/- 7 mm Hg. In about 50% of the patients collaterals to the infarct-related coronary artery could be documented. With the first contrast injection into the infarct-related vessel TIMI flow 0/I was demonstrated in 94.9%, TIMI flow II in 5.7% and TIMI flow III in 0.4%. Reopening of the infarct-related coronary artery with establishment of TIMI-flow III was primarily successful in 91.9%. Average time for coronary angiography and angioplasty in the cathlab was 69 +/- 28 min. In 29 patients an autoperfusion balloon catheter was used to treat manifest or threatening reocclusion. Thirty-day-mortality in the total study group was 3.4%. In patients aged > or = 70 years mortality raised to 14.3%; in patients in cardiogenic shock mortality increased to 18.7%, in patients with inferior wall infarction up to 5.5%, and in cases with multi-vessel disease up to 5.0%. The in-hospital and 30-day course were complicated by major peripheral bleeding in seven patients (2.7%) requiring blood transfusions and surgical femoral vascular repair, and in another two patients with a false aneurysm which was treated by surgical means. No hemorrhagic stroke occurred, but three ischemic strokes with complete restitutio ad integrum within the 30-day-observation period were registered. As major cardiac complication early re-occlusion of the initially reopened infarct-related coronary artery was diagnosed in 10 patients; 11 patients developed a re-infarction within the first 30-days, in three cases leading to a fatal outcome.(ABSTRACT TRUNCATED AT 400 WORDS)