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Coronary Angiography after Thrombolytic Therapy for Acute Myocardial Infarction

1991; American College of Physicians; Volume: 114; Issue: 10 Linguagem: Inglês

10.7326/0003-4819-114-10-877

1539-3704

Eric J. Topol, David R. Holmes, William J. Rogers,

Cardiac Imaging and Diagnostics

Reviews15 May 1991Coronary Angiography after Thrombolytic Therapy for Acute Myocardial InfarctionEric J. Topol, MD, David R. Holmes, MD, William J. Rogers, MDEric J. Topol, MD, David R. Holmes, MD, William J. Rogers, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-114-10-877 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPurpose: To review the status of emergency, urgent, routine, and selective angiography after intravenous thrombolytic therapy.Data Sources: Relevant English-language articles published from January 1985 to July 1990 were identified through MEDLINE.Study Selection: For emergency angiography, four major randomized studies were reviewed and data from nine studies that incorporated rescue coronary angioplasty were pooled for metaanalysis. For urgent angiography, two controlled trials were reviewed. Comparisons of routine and selective angiography were done using data from two dedicated, large-scale, controlled trials and the ancillary findings of four other studies of reperfusion that incorporated angiography.Data Extraction: The review emphasizes the findings from multicenter, randomized, controlled trials.Data Synthesis: Emergency coronary angiography is done pri marily in preparation for primary or rescue angioplasty; the value of rescue angioplasty has yet to be assessed in a randomized trial, but technical success and reocclusion improve significantly after therapy with nonspecific plasminogen activators compared with relatively specific agents (success rate, 86% compared with 75%, respectively; P = 0. 03; reocclusion rate, 10.9% compared with 26.8%, respectively; P < 0.001). Urgent coronary angiography has value for treating recurrent ischemia, but patients who develop this complication after thrombolysis are likely to have a suboptimal outcome despite aggressive care. Studies support the use of either selective or routine angiography in uncomplicated patients after thrombolytic therapy; either approach is acceptable, but the former is more practical and may prove to be cost effective.Conclusions:Optimal follow-up for patients with evolving myocardial infarction who receive thrombolysis may incorporate coronary angiography at various stages. Although our ability to noninvasively detect reperfusion, reocclusion, or viable but ischemic myocardium is limited at present, available data may assist in selecting a catheterization strategy....References1. . Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet. 1986;1:397-402. MedlineGoogle Scholar2. . Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet. 1988;2:349-60. MedlineGoogle Scholar3. . 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Does inappropriate use explain small-area variations in the use of health care services? JAMA. 1990;263:669-72. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Eric J. Topol, MD; David R. Holmes, MD; William J. Rogers, MDFrom the University of Michigan School of Medicine, Ann Arbor, Michigan; the Mayo Clinic School of Medicine, Rochester, Minnesota; and the University of Alabama at Birmingham, Birmingham, Alabama. For current author addresses, see end of text. 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