Influence of collateral circulation on in-hospital death from anterior acute myocardial infarction.

OBJECTIVES: Our purpose was to study whether the in-hospital prognosis of anterior acute myocardial infarction (AMI) is influenced by preexistent collateral circulation to the infarct-related artery. BACKGROUND: Collateral circulation exerts beneficial influences on the clinical course after AMI, but demonstration of improved survival is lacking. METHODS: We studied 238 consecutive patients with anterior AMI treated by primary angioplasty within the first 6 h of the onset of symptoms. Fifty-eight patients with basal Thrombolysis in Myocardial Infarction (TIMI) flow >1 in the infarct-related artery or with inadequate documentation of collateral circulation were excluded. Collateral channels to the infarct-related artery before angioplasty were angiographically assessed, establishing two groups: 115 patients (64%) without collateral vessels (group A) and 65 patients (36%) with collateral vessels (group B). RESULTS: There were no differences in baseline characteristics between groups A and B, except for the greater prevalence of previous angina in group B (15% vs. 34%, p = 0.003). During the hospital stay, 26 patients (23%) in group A and 5 (8%) in group B died (p = 0.01). Cardiogenic shock accounted for 74% of deaths. Cardiogenic shock developed in 30 patients (26%) in group A and in 4 (6%) in group B (p = 0.001). The absence of collateral circulation appeared to be an independent predictor of in-hospital death (odds ratio 3.4, 95% confidence interval 1.2 to 9.6, p = 0.02) and cardiogenic shock (odds ratio 5.6, 95% confidence interval 1.9 to 17, p = 0.002). CONCLUSIONS: Preexistent collateral circulation decreases in-hospital death from anterior AMI by reducing the incidence of cardiogenic shock.

Primary angioplasty versus systemic thrombolysis in anterior myocardial infarction.

OBJECTIVES: This study compares the efficacy of primary angioplasty and systemic thrombolysis with t-PA in reducing the in-hospital mortality of patients with anterior AMI. BACKGROUND: Controversy still exists about the relative benefit of primary angioplasty over thrombolysis as treatment for AMI. METHODS: Two-hundred and twenty patients with anterior AMI were randomly assigned in our institution to primary angioplasty (109 patients) or systemic thrombolysis with accelerated t-PA (111 patients) within the first five hours from the onset of symptoms. RESULTS: Baseline characteristics were similar in both groups. Primary angioplasty was independently associated with a lower in-hospital mortality (2.8% vs. 10.8%, p = 0.02, adjusted odds ratio 0.23, 95% confidence interval 0.06 to 0.85). During hospitalization, patients treated by angioplasty had a lower frequency of postinfarction angina or positive stress test (11.9% vs. 25.2%, p = 0.01) and less frequently underwent percutaneous or surgical revascularization after the initial treatment (22.0% vs. 47.7%, p < 0.001) than did patients treated by t-PA. At six month follow-up, patients treated by angioplasty had a lower cumulative rate of death (4.6% vs. 11.7%, p = 0.05) and revascularization (31.2% vs. 55.9%, p < 0.001) than those treated by t-PA. CONCLUSIONS: In centers with an experienced and readily available interventional team, primary angioplasty is superior to t-PA for the treatment of anterior AMI.

Frequency of left ventricular free-wall rupture in patients with acute myocardial infarction treated with primary angioplasty.

A total of 590 patients with myocardial infarction treated with primary angioplasty were studied, to assess the incidence and related factors of free-wall rupture in patients with acute myocardial infarction when treated with primary angioplasty. The incidence of free-wall rupture was 2.2% (13 patients); this incidence was higher in patients >65 years old, women, nonsmokers, as well as in those with anterior location and an initial TIMI grade 0 flow, but it was similar in patients with a successful or unsuccessful angiographic result.

Efficacy of invasive strategy for the management of acute myocardial infarction complicated by cardiogenic shock.

This retrospective study evaluates the influence of an invasive strategy of urgent coronary revascularization on the in-hospital mortality of patients with acute myocardial infarction (AMI) complicated early by cardiogenic shock. Among 1,981 patients with AMI admitted to our institution from 1994 to 1997, 162 patients (8.2%) developed cardiogenic shock unrelated to mechanical complications. The strategy of management was considered invasive if an urgent coronary angiography was indicated within 24 hours of symptom onset. Every other strategy was considered conservative. Fifty-seven patients who developed the shock late or after a revascularization procedure, or who died on admission, were excluded. The strategy was invasive in 73 patients (70%). Five of them died before angiography could be performed and 65 underwent angioplasty (success rate 72%). By univariate analysis the invasive strategy was associated with a lower mortality than conservative strategy (71% vs 91%, p = 0.03), but this association disappeared after adjustment for baseline characteristics. Older age, nonsmoking, and previous ischemic heart disease were independent predictors of mortality. In conclusion, we have failed to demonstrate that a strategy of urgent coronary revascularization within 24 hours of symptom onset for patients with AMI complicated by cardiogenic shock is independently associated with a lower in-hospital mortality. This strategy was limited by the high mortality within 1 hour of admission in patients with cardiogenic shock, the modest success rate of angioplasty in this setting, and the powerful influence of some adverse baseline characteristics on prognosis.

Early coronary angioplasty for acute myocardial infarction: predictors of poor outcome in a non-selected population.

AIMS: The objective of this study was to report the experience in the treatment of acute myocardial infarction (AMI) with early coronary angioplasty (PTCA) in a single European center during one decade, attempting to identify the characteristics associated with a poor prognosis in these patients. METHODS AND RESULTS: Eight hundred patients with AMI were treated with PTCA < 12 hours after symptom onset. Mean age was 64 +/- 13 years, 12% were in cardiogenic shock, AMI location was anterior in 61% and PTCA was performed after failed thrombolysis in 5%. Coronary stents and abciximab were used in 51% and 10%, respectively. An angiographic successful result was obtained in 93%, and final TIMI flow grade 3 was achieved in 83%. The overall in-hospital mortality rate was 12.5% (2.7%, 16.1%, 25.7% and 63.8% in patients in Killip class I, II, III and IV, respectively). Over the years, an improvement in the angiographic results and a reduction in the rates of reinfarction and target vessel revascularization were observed. The independent predictors of death were age > 70 years, absence of hyper-cholesterolemia, anterior location, cardiogenic shock, multi-vessel disease and unsuccessful PTCA. The leading causes of mortality were cardiogenic shock (63%) and ventricular free wall rupture (14%). The rates of non-fatal reinfarction, documented reocclusion and in-hospital repeated revascularization were 2%, 3% and 4%, respectively. CONCLUSION: In most cases, PTCA performed in a non-selected patient population with AMI results in angiographic success. Mortality especially occurs in patients who are in cardiogenic shock at the beginning of the procedure. We have observed an improvement in the results throughout the course of the decade.

Early coronary angioplasty for acute myocardial infarction complicated by cardiogenic shock: have novel therapies led to better results?

Patients with acute myocardial infarction (MI) and cardiogenic shock constitute a very high risk subset despite an aggressive management. The objective of this study was to evaluate if the results of early coronary angioplasty in patients with acute myocardial infarction and cardiogenic shock have changed over the last years, and to address which role the recent adjuvant therapies have played in this evolution. From 1991 to April 1999, 94 patients with acute MI and cardiogenic shock were treated with coronary angioplasty within the first 12 hours from the onset of symptoms. Temporal changes of the utilization of adjuvant therapies and operators experience were studied over these years, as well as their impact on the angiographic results and in-hospital outcome. Over the years, a progressive and significant increase on the use of coronary stents and c7E3Fab was observed, as well as an increased number of primary angioplasties performed per month. The proportion of patients treated with intraaortic balloon pump did not changed significantly over the years. An angiographic successful result (< 50% residual stenosis and TIMI flow 2 or 3) and a final TIMI grade 3 flow were obtained in 76 (80.9%) and 61 (64.9%) patients, respectively. The angiographic success rate progressively increased over the years, from 72.3% in patients treated before 1994 to 94.1% in those admitted in 1998Eth 1999 (p for trend 0.0409). The proportion of patients with a final TIMI grade 3 flow also grew progressively over the years: from 36.4% before 1994 to 76.5% after 1997 (p for trend 0. 0209). The overall in-hospital mortality rate was 63.8% (60 patients), and there was no significant change in mortality rate over the years. Therefore, apart from the growing operators experience, we have observed an incremental change in the use of coronary stents and c7E3 Fab (abciximab) in patients with acute myocardial infarction and cardiogenic shock treated with early coronary angioplasty. All these factors have led to an improvement in the angiographic results, although this change has not meant a significant reduction of mortality.

[Is there one type of stent for every lesion?]. / Existe un tipo de stent para cada lesión?

Intracoronary stents are, without any doubt, a major breakthrough in interventional cardiology. Their widespread use has expanded to more difficult anatomical situations and the search for more suitable stents continues to grow. We review, in this paper, the technical characteristics of stents that are currently approved or in clinical investigation. We have also reviewed the role of intravascular ultrasound in the study of the anatomical characteristics of plaque, the length of the lesion, and their influence of the stent selection and the ultrasound influence on the determination of appropriate stent expansion. After reviewing the current role of the intracoronary stent, we tried to look for the most appropriate stent in three "unconventional" anatomical situations: long and bifurcated lesions, lesions containing thrombus and saphenous vein aortocoronary bypass grafts. In conclusion, the intracoronary stent plays a major role in interventional cardiology. The second and third generation stents are more suitable for "specially difficult" situations, but there are some lesions such as bifurcations where the is not yet a definitive solution.

[Results of coronary stenting in acute myocardial infarction]. / Resultados de la implantación de stent coronario en el infarto agudo de miocardio.

OBJECTIVE: To describe the angiographic results and the in-hospital clinical outcome of patients with an acute phase of myocardial infarction treated with coronary angioplasty and stent placement. METHODS: 268 patients with myocardial infarction were treated with angioplasty and coronary stenting within in our center 12 hours after the onset of symptoms from January in 1992 to March 1998. 366 stents were placed (1.4 +/- 0.7 per patient), 35% being Palmaz-Schatz, 26% Wiktor, 21% Multi-Link and 18% others. Stenting was elective in 171 patients (64%), and the majority of patients (91%) were treated with aspirin plus ticlopidine. RESULTS: A successful angiographic result was achieved in 258 patients (96%). Minimum lumen diameter was increased from 0.2 +/- 0.3 to 2.7 +/- 0.7 mm (p < 0.001), and stenosis decreased from 94 +/- 8% to 13 +/- 11% (p < 0.001). Mortality was 15.3% (3.2%, 24.4% and 67.7% in patients in Killip class I, II-III and IV, respectively). Nonfatal reinfarction and recurrent ischemia rates were 2.6% and 9%, respectively. Stent thrombosis occurred in 8 patients (3.0%), and new target vessel revascularization was needed in 12 (4.5%). CONCLUSIONS: Stent placement in acute myocardial infarction is associated with high angiographic success rate, as well as a good in-hospital outcome. Mortality is localized, especially in patients with cardiac failure at the beginning of the procedure.

[Feasibility and safety of intracoronary ultrasound. Experience of a single center]. / Viabilidad y seguridad del empleo de la ecografía intracoronaria. Experiencia de un centro.

BACKGROUND AND OBJECTIVES: Intracoronary ultrasound provides a number of advantages in the quantification and characterization of coronary stenoses with regard to contrast angiography. However, previous studies have reported a 3.5 to 11% complication rate, and a 10-30% failure rate in performing this technique. The purpose of the study is to analyze the feasibility of performing intracoronary ultrasound and the incidence of complications associated with the use of contemporary, state of the art equipment. MATERIAL AND METHODS: The feasibility of performing intracoronary ultrasound, analyzed as the percentage of successes and failures in performing the examination was reviewed, as well as the complication rate associated with the technique in all the procedures carried out between July 1, 1994 and February 29, 1996 in which intravascular ultrasound was attempted. Complications were categorized as related, non-related and uncertainly related to the ultrasound study. RESULTS: 239 vessels were studied with intravascular ultrasound in 209 procedures (74% interventional) performed on 139 patients. Ultrasound examination was feasible in all the diagnostic studies and in 96% of the interventional procedures. The major and minor procedural complication rate was 2.4 and 10.5% respectively. No major complication was related to the ultrasound examination. Three patients experienced minor complications (1.4%) related to the ultrasound study. All three complications occurred in baseline studies during interventional procedures. CONCLUSIONS: Intracoronary ultrasound is feasible and safe in the vast majority of the procedures. Improvements in smaller catheter size and design and larger operator expertise have significantly reduced the complication rate, particularly the most frequent coronary spasm so far. Complications are associated with baseline studies during interventional procedures and with less operator expertise.

[In-hospital major complications associated with rotational atherectomy: experience with 800 patients at a single center]. / Complicaciones mayores intrahospitalarias asociadas a la aterectomía rotacional: experiencia con 800 pacientes en un solo centro.

INTRODUCTION: Rotational atherectomy is usually performed in patients with angiographically determined high risk coronary lesions. The aim of this study was to evaluate the rate of major adverse cardiac events (death, Q-wave infarction or new revascularization) after rotational atherectomy, as well as to identify the clinical characteristics associated with this incidence. PATIENTS AND METHODS: The study population included 800 patients treated with rotational atherectomy from 1993 to 1999: 512 (64%), for de novo lesions, and 288 (36%) for restenosis. Balloon dilation and coronary stenting was performed in 95% and 34% of patients, respectively. RESULTS: During hospitalization, 17 patients (2.1%) died, 16 (2%) had a Q-wave infarction, 30 (3.8%) a non-Q infarction, and new revascularization was performed in 28 (3.5%). The incidence of major adverse cardiac events was 6.5% (n = 52), this incidence being higher in the presence of diabetes (8.9 vs. 4.4%; p = 0.01), unstable angina or acute/recent myocardial infarction (7.6 vs. 3.3%; p = 0.02), multivessel disease (8.6 vs. 3.3%; p < 0.01), treated vessel other than right coronary (7.0 vs. 1.7%; p = 0.01), procedure in > 1 vessel (10.7 vs. 4.7%; p < 0.01), angiographic failure (62.5 vs. 5.5%; p < 0.001), and de novo lesions (8.4 vs. 2.5%; p < 0.01), with diabetes and treatment of de novo lesions being independent predictors of major adverse cardiac events. However, age, previous infarction, and left ventricular dysfunction, were not associated with the rate of events. CONCLUSION: Some simple variables are associated with a higher incidence of major adverse cardiac events after rotational atherectomy. Advanced age, previous infarction and left ventricular dysfunction, however, do not necessarily imply a poorer prognosis in these patients.

[Coronary endoprosthesis (stents) implanted without coumadin administration: one year's experience]. / Implantación de endoprótesis coronarias (stents) sin dicumarínicos: un año de experiencia.

BACKGROUND AND OBJECTIVES: Subacute occlusion and bleeding complications have been the major limitations of coronary stenting. Several authors have suggested the nonessential role of oral anticoagulation to prevent occlusions. METHODS: We treated 121 patients (125 stent procedures with initial angiographic success) with the following regimen: heparin 10-20,000 IU i.v. and ASA 325 mg i.v. during the procedure, followed by ASA 125-325 mg/day/6 months and ticlopidine 250-500 mg/day/3 months. 40 patients were also treated with enoxaparine (14,000 IU/day, median) for 10 days. RESULTS: 172 stents (119 Palmaz-Schatz, 35 Wiktor and 18 of other types) were implanted in 148 lesions (in 45 cases with non-occlusive dissection or suboptimal results and the rest electively). Most of the stents were deployed at high pressure (median 14 atm.). The procedure was ended when the stent expansion was considered as optimal by angiography and/or intravascular ultrasound. No patient developed signs of subacute occlusion at follow-up (30-441 days). 2 patients developed non-Q wave myocardial infarction (occlusion of side branches). The rates of bleeding and vascular complications were 0.8% and 1.6%, respectively. CONCLUSIONS: Coronary stenting with high pressure dilatation and without subsequent anticoagulation seems to be associated with low rates of subacute occlusion and bleeding or vascular complications.

[Wiktor stent in de novo lesions: immediate results in 100 consecutive patients]. / Stent de Wiktor en lesiones de novo: resultados inmediatos en 100 pacientes consecutivos.

BACKGROUND: Randomized trials which compare different stents are lacking and the studies to test the behavior of the Wiktor stent in de novo lesions have not been substantiated by large numbers and with consistent results. METHODS: The lesions were predilated with a conventional balloon 1/2 mm smaller in diameter than the stent to be used. The overdilation was done with the same balloon in which the stent comes mounted. The quantitative coronary analysis was "off line" by the automatic edge detection method with the CMS system by Medis. The post implantation treatment was aspirin and ticlopidine in most of the patients and they were discharged 24-48 hours after the procedure. RESULTS: In one hundred consecutive patients 112 Wiktor stents were attempted to treat 106 de novo lesions. All stents but one were successfully implanted. The quantitative coronary analysis of the treated lesions showed a pre-procedure minimal luminal diameter of 0.85 +/- 0.65 mm for a reference diameter of 3.18 +/- 0.49 mm. The minimal luminal diameter after stent implantation was 2.97 +/- 0.39 mm for a reference diameter of 3.42 +/- 0.46 mm. The diameter stenosis changed from 73 +/- 18% pre-procedure to 13 +/- 9% after stent implantation. One patient was sent to emergency surgery. Another patient was referred for a semiselective bypass surgery. There was no mortality. One patient suffered a non Q wave myocardial infarction. There were no important bleeding complications. There were no cases of subacute thrombosis. All the patients were contacted by telephone one month after the procedure. CONCLUSIONS: In this study we have demonstrated that Wiktor stent implantation is associated with excellent immediate results. The new model makes stent implantation a rapid, safe and relatively easy procedure. If the angiographic result is good, there is no need for an stringent anticoagulation regimen. We have to wait for long term clinical and angiographic results to determine the role of Wiktor stent in novo lesions.

[Primary coronary angioplasty in acute anterior myocardial infarction: immediate results]. / Angioplastia primaria en el infarto agudo de miocardio de localización anterior: resultados inmediatos.

BACKGROUND: Some reports have indicated that primary angioplasty not contaminated by previous intravenous infusion of thrombolytic agents represents an efficient approach to the treatment of acute myocardial infarction. PATIENTS AND METHODS: As a part of a more ambitious protocol aiming to compare primary angioplasty and intravenous recombinant tissue plasminogen activator, we performed direct coronary angioplasty in 33 patients (18 randomized to angioplasty and 15 because of contraindication to thrombolysis) that were admitted to our hospital with acute myocardial infarction with less than 5 hours elapsed from the onset of pain and with clear electrocardiographic criteria of anterior infarction. RESULTS: In 30 of the 33 patients (90.9%) the left anterior descending artery was recanalized and TIMI 2 flow in 17 and 3 in 13 was obtained. The average time elapsed from the onset of pain to the opening of the artery was 228 +/- 70 (120-390) minutes and from the time of admission to the coronary care unit to complete reperfusion 91 +/- 43 minutes (33-120). Thirty one patients (93.9%) were discharged from the hospital and two (6.1%) died. There was only one hemorrhagic complication without sequelae. CONCLUSIONS: Primary coronary angioplasty in acute anterior myocardial infarction is an efficient, safe and not so difficult therapeutic strategy. Even though it requires a complex around the clock on call set up it is specially useful in specific subsets of patients.

[Experience with the Palmaz-Schatz stent in the treatment of postangioplasty coronary dissection]. / Experiencia con el stent de Palmaz-Schatz en el tratamiento de la disección coronaria postangioplastia. Resultados a corto y medio plazo.

Some authors have proposed the use of coronary stenting as a good therapeutic strategy for post angioplasty acute coronary dissection. We present our experience with the Palmaz-Schatz stent for the treatment of acute coronary dissection after percutaneous coronary angioplasty. Twenty five stents were deployed in nineteen patients with occlusion (7) or threatened occlusion (12). Eleven patients (58%) had multivessel disease, seven (37%) unestable angina and six (32%) previous myocardial infarction. The attempted lesion was type A in four patients (21%), type B in thirteen (68%) and type C in two (11%) according to the American College of Cardiology/American Heart Association classification. To cover the dissection was necessary to deploy three stents in two patients, and two stents in two more. The other fifteen patients received one stent each. In eighteen patients (95%) the stent deployment was accomplished with immediate angiographic success. Twelve stents were deployed in the right coronary artery, eight in the left anterior descending and five in the circumflex. In sixteen patients (84%) the stent successfully solved the occlusion or threatened occlusion reassuming a normal coronary flow. There were 10 complications in six patients: one death (5%), 3 cases of emergency coronary artery bypass graft (16%), 2 acute myocardial infarction (11%), 2 hemorrhagic complications (11%) and 2 cases of subacute thrombosis of the stent (11%). The Palmaz-Schatz stent seems to be a useful tool for the management of acute coronary dissection with a fair number of complications. The results obtained during hospitalization are maintained with a more than acceptable restenosis rate.

[Results of primary angioplasty in patients with multivessel disease]. / Resultados de la angioplastia primaria en pacientes con enfermedad multivaso.

INTRODUCTION: In patients with acute myocardial infarction treated with primary angioplasty, multivessel disease is associated with a higher mortality. However, if higher mortality is simply due to a higher prevalence of cardiogenic shock or if multivessel disease is an independent risk factor remains unclear. OBJECTIVES: To study if multivessel disease constitute an independent prognostic factor in patients with acute myocardial infarction treated with primary angioplasty, and to ascertain possible mechanisms contributing to the worse prognosis found in these patients. PATIENTS AND METHODS: Between august 1991 and october 1996, 312 patients with acute myocardial infarction were treated with primary angioplasty in our center. Characteristics and in-hospital outcome of patients with or without multivessel disease were compared. RESULTS: Patients with multivessel disease (n = 158; 51%) were older (64 +/- 11 vs 61 +/- 13 years; p = 0.017), less often smokers (60% vs. 76%; p = 0.006) and had a higher prevalence of diabetes (35% vs. 20%; p = 0.007), hypertension (54% vs. 39%; p = 0.012), prior acute myocardial infarction (29% vs. 5%; p < 0.001), prior coronary bypass (2% vs. 0%; p = 0.042) and Killip class IV at admission (19% vs. 8%; p < 0.001). Angiographic success rate was not different in patients with or without multivessel disease (89% vs. 92%; NS). Patients with multivessel disease had a higher in-hospital mortality (21% vs. 7%; p < 0.001), need of revascularization (17% vs. 3%; p < 0.001) and incidence of severe mitral regurgitation, (5% vs. 0%; p < 0.001), second or third atrioventricular blockade (10% vs. 1%; p < 0.001) and severe bleeding (4% vs. 1%; p = 0.089). After excluding patients with Killip class III or IV at admission, mortality was also higher in patients with multivessel disease (9% vs. 2%; p = 0.009). Multivariate analysis showed the following independent risk factors for mortality: age > 65 years, Killip class IV and multivessel disease. CONCLUSIONS: In patients with acute myocardial infarction treated with primary angioplasty, multivessel disease is associated with higher mortality. This is due not only to a higher prevalence of cardiogenic shock at admission, but also to a worse baseline profile, a higher incidence of complications and a more frequent need of revascularization.

[Coronary angioplasty in the acute myocardial infarction: in which patients is it less likely to obtain an adequate coronary reperfusion?]. / Angioplastia coronaria en el infarto agudo de miocardio: en qué pacientes es menos probable obtener una reperfusión coronaria adecuada?

INTRODUCTION: In patients with acute myocardial infarction treated with primary angioplasty, the inability to achieve successful coronary reperfusion is associated with higher mortality. The objective of the study was to identify which characteristics may predict a lower angiographic success rate in patients with acute myocardial infarction treated with coronary angioplasty. PATIENTS AND METHODS: The study population is constituted by the 790 patients with acute myocardial infarction that were treated with angioplasty within the 12 hours after the onset of symptoms from 1991 to 1999 at our institution. A successful angiographic result was considered in presence of a residual stenosis < 50% and a TIMI flow 2 or 3 after the procedure. RESULTS: A successful angiographic result and a final TIMI 3 flow were achieved in 736 (93.2%) and 652 (82.5%) patients, respectively. In-hospital mortality was higher in patients with angiographic failure than in those with angiographic successful result (48 vs. 10%; p < 0.01). Age under 65 (91 vs. 95%; p = 0.02), non smoking (90 vs. 96%; p < 0,01), previous infarction (87 vs. 94%; p < 0.01), angioplasty after failed thrombolysis (83 vs. 94%; p = 0. 02), cardiogenic shock (80 vs. 95%; p < 0.01), undetermined location (67 vs. 93%; p < 0.01), non-inferior location (92 vs. 96%; p = 0.04), left bundle branch block (64 vs. 94%; p < 0.01), multivessel disease (91 vs. 95%; p = 0.02), left ventricular ejection fraction < 0.40 (89 vs. 97%; p < 0.01), no utilization of coronary stenting (90 vs. 96%; p < 0.01), and use of intraaortic balloon counterpulsation pump (82 vs. 95%; p < 0.01) were associated with a lower angiographic success rate. In the multivariable analysis, the following were independent predictors for angiographic failure: left bundle branch block (odds ratio [OR], 12.95; CI 95%, 3.00-53.90), cardiogenic shock (OR, 4.20; CI 95%, 1.95-8.75), no utilization of coronary stent (OR, 3.44; CI 95%, 1.71-7.37), and previous infarction (OR, 2.82; CI 95%, 1.29-5.90). CONCLUSIONS: Coronary angioplasty allows a successful coronary recanalization in most patients with acute myocardial infarction. Some basic characteristics, however, may identify some subsets in which a successful angiographic result may be more difficult to obtain.