Myocardial infarction – stent placement
Coronary angioplasty with stent implantation in the early hours of acute myocardial infarction may be: primary angioplasty, angioplasty associated with pharmacological reperfusion therapy and rescue angioplasty (if pharmacological therapy was not successful).
Compared with fibrinolytic therapy performed in the first 6-12 hours after symptoms started the primary coronary angioplasty has proven a more effective restoration of blood flow in obstructed coronary artery, a lower incidence of reocclusion, a better left ventricular function and a better prognosis for long-term, a decrease in mortality.
Percutaneous transluminal angioplasty is the preferred intervention for myocardial reperfusion in patients with myocardial infarction if it can be done as soon as possible from the first medical contact. This should be done within 2 hours after first medical contact. Primary angioplasty is a firm indication in patients with cardiogenic shock and in case of contraindication to fibrinolysis (pharmacological reperfusion).
In the acute phase of myocardial infarction it will be dilated only the responsible lesion for ischemia and the other injuries, if any, will be resolved later. Stent implantation will be performed routinely in patients with myocardial infarction as in the studies this procedure has proven superiority over simple balloon angioplasty.
Facilitated angioplasty is no longer recommended for treatment of acute myocardial infarction, because there was a higher rate of bleeding and ischemic complications and even a trend of increasing mortality.
If after pharmacological reperfusion therapy, the infarct related artery remained occluded it will be performed rescue angioplasty. On long-term, the rescue angioplasty has proven to improve patient prognosis.
Angioplasty with stent implantation was successfully performed if residual stenosis of the coronary artery is less than 20% and no complications occurred (death, reinfarction, need for revascularization surgery) after 30 days.
Factors that predict the risk of procedural failure:
– Clinical: female, advanced age, diabetes, heart failure, kidney failure, cardiogenic shock with mounted balloon for counterpulsation, an increase of C-reactive protein prior to the procedure;
– Anatomy: if there are affected more than one coronary arteries or trunk is affected, venous by-pass, lesions with increased complexity, a chronic occlusion;
– Factors related to the procedure: coronary dissection or residual stenosis.