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[Relation of angina pectoris before myocardial infarct to coronarographic findings after thrombolytic therapy]
M Aschermann1, J Komárek, F Kölbel
1III. interní katedra I. lékarské fakulty Univerzity Karlovy, Praha.
Insights
Patients experiencing acute myocardial infarction (heart attack) with residual artery blockage after treatment face higher risks. Preinfarction angina can identify those needing early angiography to prevent reinfarction and sudden death.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Significant residual stenosis post-thrombolytic therapy for acute myocardial infarction (AMI) increases risks of reinfarction, ischemia, and sudden death.
- Early revascularization is crucial for preventing these adverse outcomes in high-risk patients.
Purpose of the Study:
- To identify patients at increased risk for complications after AMI and thrombolytic therapy.
- To evaluate the utility of preinfarction angina as a predictor for significant residual stenosis and potential candidates for early angiography.
Main Methods:
- Retrospective review of 74 patients undergoing coronary angiography after thrombolytic therapy for AMI.
- Assessment of residual stenosis in the infarct-related artery (IRA).
- Correlation of preinfarction angina (Canadian class I-IV within 24 hours pre-MI) with residual stenosis severity.
Main Results:
- 85% of patients had significant residual stenosis (≥50% diameter reduction) in the IRA.
- 58% had high-grade stenosis (≥75% diameter reduction).
- Patients with preinfarction angina exhibited higher mean residual stenosis (76.5% vs. 64%) and were more likely to have high-grade stenosis (79% vs. 21%).
Conclusions:
- Preinfarction angina is a valuable clinical indicator for identifying patients with a higher risk of IRA reocclusion after thrombolytic therapy for AMI.
- Early coronary angiography and subsequent revascularization should be considered for these high-risk patients to prevent serious complications.
Abstract:
Patients with significant residual stenosis after thrombolytic therapy during acute myocardial infarction have higher risk of reinfarction, periinfarction ischemia and sudden death. Early revascularisation can prevent such complications. To find out patients who are at increased risk and are candidates for early angiography 74 patients undergoing angiography after thrombolytic therapy were reviewed. Significant residual stenosis (greater than or equal to 50% diameter reduction) of infarct related artery was present in 85%, high grade stenosis (greater than or equal to 75%) in 58% of patients respectively. The group of patients with preinfarction angina (Canadian class I to IV. 24 hours before infarction) had higher mean residual stenosis than patients without angina (76.5% vs 64%). There was significant difference in presence of preinfarction angina in patients with high grade stenosis and without high grade stenosis (79% and 21% respectively). Thus preinfarction angina can be used to identify patients with higher risk of reocclusion after thrombolytic therapy during acute myocardial infarction. Early coronary angiography and revascularisation can prevent serious complications in these patients.