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Results From a Community Hospital

Paula F. Miller, MD; Bruce R. Brodie, MD; Richard A. Weintraub, MD; E. Joseph LeBauer, MD; Jeffrey D. Katz, MD; Thomas D. Stuckey, MD; Charles J. Hansen, MA

Arch Intern Med. 1987;147(9):1565-1570.

Abstract
• Emergency coronary angioplasty was performed in 127 patients presenting to a community hospital with acute myocardial infarction. Reperfusion and successful dilatation were performed in 117 patients (92%) at 3.3 ± 1.8 hours from the onset of pain. Eleven patients (8.6%) died, ten patients (7.9%) developed reocclusion, and ten patients (7.9%) required coronary bypass surgery during the initial hospitalization. Late restenosis occurred in 36% (27/76) of patients restudied or 27% (27/100) of patients at risk for restenosis. Ejection fraction improved in patients with patent vs occluded vessels (8.4%± 8.2% vs -4.1%±6.0%) and improved most in anterior vs inferior vs posterolateral infarcts (11.0% ±8.4% vs 6.8% ±6.4% vs 2.6%±7.5%). Posthospitalization follow-up in all patients (mean, 13.4 months) revealed only one late death. Of the patients followed up, 83% had no angina, and 17% of patients had mild angina. Our experience demonstrates that coronary angioplasty for acute myocardial infarction can be performed in the community hospital by an experienced cardiovascular laboratory team with a high success rate, a low reocclusion rate, an improvement in ejection fraction, and an excellent long-term prognosis. The community hospital setting allows early access to patients and creates the potential for early reperfusion and myocardial salvage.

(Arch Intern Med 1987;147:1565-1570)

Author Affiliations
From the Department of Medicine, The University of North Carolina School of Medicine, Chapel Hill, and Department of Medicine, Moses H. Cone Memorial Hospital, Greensboro, NC (Drs Miller, Brodie, Weintraub, LeBauer, Katz, and Stuckey) and Bowman Gray School of Medicine, Winston-Salem, NC (Mr Hansen).

Footnotes
Accepted for publication March 31, 1987.

Reprint requests to 721 Green Valley Rd, Greensboro, NC 27408 (Dr Brodie).

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