A Comparison of Outcomes of Routine Early Angiography versus Delayed Ischemia-Guided Angiography after Thrombolytic Therapy in ST Segment-Elevation Myocardial Infarction

Background: Thrombolytic therapy continues to be the common treatment in acute ST elevation myocardial infarction in the majority of heart centers worldwide. However, thrombolytic therapy is associated with high re-occlusion and re-infarction rates. So, most patients now undergo early diagnostic angiography and possibly angioplasty of the culprit artery but the controversy about the timing of angiography after thrombolysis continues to remain unresolved. In this prospective cohort study, we compared the outcome of early invasive strategy versus delayed invasive approach in ST-elevation MI patients who had received successful thrombolytic therapy. Primary endpoint of the study was Major Adverse Cardiovascular Events or MACE ( the combined rate of death, re-infarction, major bleeding and cerebrovasular events. Secondary endpoints were re-infarction and re-hospitalization rate.

Method: The study comprised 142 patients of which 87 had a routine angiography in less than 10 days of acute event and 55 underwent ischemia-guided angiography after 10 days of index event. Stenting of the culprit vessel was done in 60% of the routine angiography group and 63% of the ischemia-guided group. The patients were followed for 8.8 ± 2.8 months after the index event.

Results: The primary endpoint occurred in 6.9% of routine angiography patients and 10.9% of the control group (P= 0.4). The rate of re-infarction was significantly higher in the delayed invasive arm than routine early invasive arm (10.9% vs. 1.1, P:0.01),and mostly occurring before angiography.

Conclusion: routine angiography as soon as possible after thrombolysis can reduce re-infarction and was not associated with any increased risk of adverse events in our study.