Recurrent ischemia after thrombolysis for acute myocardial infarction

Related Experiment Video

Updated: Oct 9, 2026

A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
06:01

A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia

Published on: August 18, 2015

L Pilote1, D P Miller, R M Califf

  • 1Montreal General Hospital, Montreal, Quebec, Canada.

American Heart Journal
|March 29, 2001
PubMed

Insights

Recurrent ischemia after acute myocardial infarction is predicted by female sex, hypercholesterolemia, and prior angina. Early coronary angiography significantly reduces recurrent ischemia risk in these patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • Predicting recurrent ischemia after acute myocardial infarction (AMI) thrombolysis remains challenging.
  • The role of early coronary angiography in identifying patients at risk for recurrent ischemia is not well-defined.

Purpose of the Study:

  • To investigate predictors of recurrent ischemia following thrombolysis for AMI.
  • To determine the impact of early cardiac procedures, specifically coronary angiography, on recurrent ischemia.

Main Methods:

  • Analysis of data from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) trial.
  • Prospective study defining recurrent ischemia as angina with hemodynamic or electrocardiogram changes.
  • Cox regression analysis to identify predictors and assess the effect of coronary angiography and revascularization.

Main Results:

  • Recurrent ischemia occurred in 29% of 21,772 US patients.
  • Predictors of increased risk included female sex, hypercholesterolemia, and prior angina.
  • Current smoking and faster thrombolysis were associated with lower risk; early angiography ultimately reduced recurrent ischemia risk.

Conclusions:

  • Female sex, hypercholesterolemia, prior angina, and nonsmoking status are weak predictors of recurrent ischemia.
  • Early coronary angiography appears to reduce recurrent ischemia, likely by facilitating identification and revascularization of high-risk patients.
Abstract

More Related Videos

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Related Concept Videos

Transient Ischemic Attack l: Introduction01:26

Transient Ischemic Attack l: Introduction

A transient ischemic attack (TIA) is a brief episode of neurological dysfunction caused by a temporary, focal reduction in cerebral blood flow. Although symptoms resemble those of an ischemic stroke, the interruption in perfusion is short-lived and does not cause permanent infarction. TIAs are clinically important because they often serve as early warning events for future stroke.Mechanisms of Transient Cerebral IschemiaTransient cerebral ischemia may arise through several mechanisms. One...
Ischemic Stroke l: Introduction01:15

Ischemic Stroke l: Introduction

Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
Ischemic Stroke ll: Pathophysiology01:15

Ischemic Stroke ll: Pathophysiology

An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
Acute Coronary Syndrome I: Introduction01:30

Acute Coronary Syndrome I: Introduction

Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations01:19

Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations

The pathophysiology of Acute Coronary Syndrome [ACD] involves several key processes:The main underlying cause of ACD is atherosclerosis, a chronic inflammatory disease characterized by the buildup of lipid-laden plaques within the coronary arteries.As the atherosclerotic plaque grows in the coronary artery, it may become unstable due to the formation of a lipid-rich core and a thin fibrous cap. Inflammatory cells within the plaque, such as macrophages, secrete enzymes that degrade the...