July 1989

Nonemergent Cardiac Catheterization and Risk-Stratified Revascularization Following Thrombolytic Therapy for Acute Myocardial InfarctionA Critical Analysis of Therapy in the Community Setting

Author Affiliations

the University of North Carolina Cardiology Consortium

From the Division of Cardiology, School of Medicine, University of North Carolina at Chapel Hill.

Arch Intern Med. 1989;149(7):1611-1617. doi:10.1001/archinte.1989.00390070123020

• We evaluated a strategy for administering thrombolytic therapy without emergent cardiac catheterization to patients with acute myocardial infarction in community hospitals. Fifty-nine patients were treated with intravenous streptokinase and heparin, and referred for elective catheterization. Angioplasty or bypass surgery was performed only in patients judged to be at risk for reinfarction. One or more predetermined criteria for infarct segment viability were present in 47(80%) of 59 patients. Angina recurred in 24 patients and enzyme-positive reinfarction in 9 patients, but only 2 patients developed new Q waves or a creatine kinase rise to over twice the normal value. Of 18 patients judged to be at low risk for reinfarction, only 1 required urgent angioplasty or bypass surgery. Fourteen-day mortality was 7% and infarct vessel patency was 94%. These data indicate that physicians in small community hospitals with a close relationship to a referral center and with a carefully designed protocol can administer thrombolytic therapy safely and effectively. By subsequent stratification of patients according to the risk of recurrent infarction, 22% of patients eligible for revascularization were spared urgent angioplasty or bypass surgery.

(Arch Intern Med. 1989;149:1611-1617)