[Should coronary angiography be practiced in patients with recent myocardial infarction?].
As a rule, infarction results from an occlusive thrombosis in a pre-existing atherosclerotic stenosis. Contrary to intravenous thrombolysis, coronary arteriography with immediate removal of obstruction can only be performed in a minority of patients. Similarly, "salvage angioplasty", performed if thrombolysis has failed, does not justify early coronary arteriography, except in certain cases of infarction at very high risk. In 80% of the cases the first days are uneventful, but the mortality in the first year (about 10%) will depend upon the presence or absence of latent residual ischaemia and/or left ventricular dysfunction. A noninvasive evaluation carried out before the patient is discharged and including clinical and echocardiographic data as well as the results of stress tests (sometimes coupled with isotopic studies) may isolate an important group of patients (40%) whose mortality rate at one year is below 3%. Systematic coronary arteriography, therefore, is not justified, especially since it facilitates the "easy" decisions of angioplasty the benefits of which has not been demonstrated in the absence of residual ischaemia during exercise.
Leroy
G
G
Service de cardiologie, Centre hospitalier, Saint-Germain-en-Laye.
D017023:Coronary Angiography / Q000706:statistics & numerical data*; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011379:Prognosis
Faut-il pratiquer une coronarographie aux patients ayant eu un infarctus du myocarde récent?