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Coronary angiography after successful thrombolysis - Is the recommended time interval of 24h an important issue?
Cátia Costa1, David Durão1, Adriana Belo2
1Hospital Santarém, Santarém, Portugal.
Insights
Performing coronary angiography after thrombolysis for ST-elevation myocardial infarction (STEMI) is crucial. Delaying angiography beyond 24 hours does not increase in-hospital mortality, but not performing it at all is linked to worse outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Percutaneous coronary intervention (PCI) is standard for ST-elevation myocardial infarction (STEMI).
- Thrombolysis is frequently used as primary therapy in many European centers.
- This study examines outcomes in STEMI patients treated with fibrinolysis.
Purpose of the Study:
- To assess if delayed coronary angiography (after 24h) post-successful thrombolysis impacts hospital complications and mortality.
- To compare outcomes between patients undergoing timely angiography, delayed angiography, and no angiography.
Main Methods:
- Retrospective analysis of 1065 STEMI patients who received successful thrombolysis.
- Patients categorized into three groups: no angiography, angiography within 24h, and angiography after 24h.
- Comparison of baseline characteristics and in-hospital complications across groups.
Main Results:
- Patients not undergoing angiography had higher Killip classes, worse left ventricle function, and more complications.
- Logistic regression identified non-performance of angiography as an independent predictor of in-hospital mortality.
- Delayed angiography (after 24h) was not associated with increased mortality compared to timely angiography.
Conclusions:
- Coronary angiography following thrombolysis is vital for STEMI patient prognosis.
- Non-performance of angiography significantly worsens outcomes.
- The recommended 24-hour interval for angiography is clinically acceptable, with no increased mortality for delayed procedures.
Introduction:
Percutaneous coronary intervention (PCI) is currently considered the gold-standard treatment of acute coronary syndromes with ST-segment elevation (STEMI). However, this is not the reality of many European centers, where thrombolysis is performed as primary therapy.
Aims:
To determine, in a STEMI population that performed successful fibrinolytic treatment, if the performance of coronary angiography after the first 24h was associated with more hospital complications, including higher mortality, compared with its performance in the recommended time.
Methods:
Retrospective study, including 1065 patients with STEMI, who performed successful thrombolysis. The population was divided in three groups: A, patients who didn't undergo coronary angiography after successful thrombolysis (n=278; 26.1%); B, patients who underwent coronary angiography in the first 24h after successful thrombolysis (n=127; 11.9%); and C, patients who underwent angiography after the first 24h (n=660; 62.0%). Groups were compared regarding their characteristics and in-hospital complications.
Results:
Groups B and C had more male patients and had younger patients than group A. Group A presented higher Killip classes at admission, more severe left ventricle dysfunction and a higher number of complications during hospitalization. Logistic regression revealed that: 1) the non-performance of coronary angiography after thrombolysis was an independent predictor of in-hospital mortality; and 2) the performance of angiography after the recommended time wasn't associated with higher mortality.
Conclusions:
Coronary angiography after thrombolysis constitutes an important strategy, whose non-performance carries worse prognosis. The time interval currently recommended of 24h seems clinically acceptable; however, its realization outside the recommended time doesn't seem to lead to higher mortality.
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