[Against routine coronary angiography after myocardial infarction]

Various arguments have been put forward to justify routine coronary arteriography after myocardial infarction. This investigation has been said to be essential to: 1) evaluate prognosis--while it has now been shown that combined data based upon coronary history, the initial clinical and electrocardiographic course and stress tests (electrocardiographic and/or isotope) carried out 10 to 20 days after the infarction have a predictive value superior to that of coronary arteriography regarding post-infarct mortality and the remaining functional capacity of the patient; 2) guide therapeutic indications--while patients evaluated as low risk on the basis of the above data, i.e. 50% of all infarction victims, would derive no benefit from myocardial revascularisation procedures; 3) obtain the best cost/efficacy ratio--while it has been shown that approaches based upon stress tests best fulfil this criterion. The authors plead for a reasoned approach in terms of the indication for post-infarction coronary arteriography, with the risk level of patients after the infarct being taken into account overall, and with case by case discussion of the usefulness of the investigation in terms of the patient's age (rarely indicated in the elderly, but also in the younger patient when free of ischemia during exercise), the coronary history (broad indications in recurrent infarctions), the initial clinical course (coronary arteriography indispensable where there is early recurrence of angina and/or severe left ventricular dysfunction with ejection fraction less than 0.45) and the results of stress tests performed 10 to 20 days after the infarct.