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Background: Based on data from the literature, it has been suggested that elderly patients with acute myocardial infarction will benefit more from primary angioplasty than from thrombolysis., Material and Methods: Data for 100 consecutive patients, age 75 years or more, presenting with an acute ST elevation myocardial infarction (STEMI) without cardiogenic shock and treated with primary angioplasty were analysed retrospectively. Some variables were compared with previously published data on a group of 100 younger patients (mean age 59) with STEMI., Results: Angiographically, the success rate of revascularization was similar between the elderly (mean age 80) and the younger STEMI patients. Mortality, both at 30 days and at 1 year, was higher among the elderly patients compared with the younger (15% vs. 1% and 21% vs. 3% respectively, both p < 0.001). In the same time period, primary angioplasty was performed in seven patients > or = 75 years who presented with cardiogenic shock at admission. All of these died during hospitalization., Interpretation: Technically, the success rate of primary angioplasty in elderly patients with STEMI was similar to that in younger STEMI patients. Mortality after 30 days was significantly higher among the elderly patients, but the mortality rate from 30 days to 1 year after the infarction was similar to that of the same age group in the general population. Patients > or = 75 years presenting with STEMI and cardiogenic shock had no benefit of angioplasty; all died during hospitalization.

Background: Achieving reperfusion as soon as possible is essential in order to reduce myocardial infarction size and thus improve prognosis. An increasing number of patients with myocardial infarction are treated with primary percutaneous coronary intervention (PCI). Technetium 99m-tetrofosmin myocardial perfusion tomography (SPECT) is a valid test for assessing myocardium at risk and final infarct size expressed by a hypoperfusion index (HPI) of the left ventricular mass., Material and Methods: 20 patients with acute ST-elevation myocardial infarction were treated with primary percutaneous coronary intervention within six hours of onset of symptoms. Myocardium at risk and final infarct size were assessed by Technetium 99m-tetrofosmin immediately before and a few hours, one week and six weeks after., Results: The hypoperfusion index immediately before percutaneous coronary intervention was 31%, four to six hours after PCI 25%, one week later 16% and six weeks later 12%, i.e. a relative reduction of 60% (p < 0.01). Anterior wall infarctions had a higher level of myocardium at risk before primary PCI compared to inferior wall infarctions (36% vs. 24%), but anterior wall infarctions had a higher salvage index compared to inferior wall infarctions., Interpretation: This non-controlled study shows a marked reduction in final infarction size in patients with acute ST-elevation myocardial infarction treated with primary PCI.

Background: There is little information available on long-term changes in left ventricular function and infarct size after acute myocardial infarction treated with primary angioplasty., Material and Methods: From 1996 to 1998, 100 consecutive patients were treated with primary angioplasty for acute ST-elevation myocardial infarction. Left ventricular ejection fraction was determined by radionuclide ventriculography before discharge, after six weeks and after a mean follow-up time of 20 months (range 11-37). Infarct size was assessed by technetium 99m-tetrofosmin myocardial perfusion tomography (SPECT) at rest, performed at the same time intervals., Results: Mean ejection fraction was 56% at discharge, 55% after six weeks and 57% after 20 months of follow-up. A mean perfusion defect of 19% was measured by SPECT after one week. After six weeks and 20 months of follow-up, the mean perfusion defects were reduced to 14% (p < 0.001) and 15%, respectively., Interpretation: Left ventricular function was well preserved and infarct sizes small to moderate 20 months (range 11-37) after primary angioplasty for acute myocardial infarction, demonstrating that the initial successful effect of the treatment was maintained.