[Implantation of coronary stents in reperfusion therapy in acute myocardial infarct].

Background: Primary coronary angioplasty was accepted as a method of choice in the reperfusion treating strategy of the ST elevation acute myocardial infarction. Since 1995, when the very good results of the stent implantation in patients with acute myocardial infarction were published, there has been a general trend to more stenting also in the Czech Republic.
Aim: The analysis of the effectivety and safety of the coronary stent implantation in acute myocardial infarction.
Methods: Prospective analysis of the patients with ST elevation acute myocardial infarction treated with primary coronary angioplasty with one coronary stent implantation at least in the period I/2000-XII/2000.
Results: In the above mentioned period the authors carried out the total of 116 primary coronary angioplasties in 116 patients with ST elevation acute myocardial infarction. Balloon angioplasty only was done in 27 patients (23.3%) only, at least one stent was implanted in 89 patients (76.7%). The average procedure time was 58 +/- 27.2 mins, fluoroscopy 10.6 +/- 6.6 mins, sciagraphy 1.8 +/- 0.7 mins. Primary angiographical result was optimal in 82 cases (92.2%) with achieving TIMI flow 3, in 5 cases (5.6%) there was slower perfusion of the infarcted artery observed with TIMI flow 2 and in 2 cases (2.2%) the authors were unsuccessful with final TIMI flow 0-1. Coronary stents were implanted in 13 cases (13.8%) without predilatation as so called "direct stenting", in 19 cases (20.2%) the planned or "elective" stenting was done, in 47 cases (50%) the suboptimal result after balloon angioplasty only was the reason for stent implantation and in 15 cases (16%) it was rescue "bail-out" stenting in complications of the balloon angioplasty only or if the result after balloon angioplasty was unsuccessful. Primary angiographical success of the stented lesion was 100% and in 14 cases (15.7%) the abciximab as a representative of IIb/IIIa platelet blockers was given. Periprocedural complications (up-to 24 hours after the procedure) in the stented group of patients occurred in 2 cases (2.2%), further serious in-hospital cardiovascular complications occurred in another 4 cases (4.4%). The total of 5 patients (5.5%) died in the hospital, out of which 4 patients (4.4%) died due to the primary cardiogennic shock and 1 patient (1.1%) admitted in pulmonary oedema died due to the heart failure progression. Excluding patients primary in cardiogennic shock the in-hospital mortality was 1.2% only. Hospital mortality in the group of patients treated with primary balloon angioplasty only was 3.7% (1 patient).
Conclusion: At present the coronary artery stenting is safe and highly effective method in acute myocardial infarction treatment.