title: Invasive strategy following fibrinolysis in ST-elevation acute myocardial infarction.
abstract: BACKGROUND
  A recognized drawback of ST-elevation acute myocardial infarction (STEMI) after fibrinolysis is persistent coronary occlusion or a less than TIMI 3 flow. The present study describes the results of systematic pre-discharge coronary angiography and revascularization, whenever indicated, following fibrinolytic therapy for STEMI.
  
  
  METHODS
  Consecutive patients admitted with the diagnosis of STEMI between April 1, 2000 and April 30, 2002 were included in the study. Patients with contraindications to thrombolytic therapy and/or patients not eligible for angiography were excluded. All patients received "accelerated" treatment with alteplase and had a coronary angiography at least 24 hours later, in order to perform, if anatomically feasible, angioplasty with stenting. Angioplasty of non-infarct-related coronary arteries was allowed. The mortality, reinfarction and new revascularization rates were evaluated during index hospitalization and up to 30 days and 6 months.
  
  
  RESULTS
  Eighty patients underwent cardiac catheterization at a median of 6.5 days following admission; in 86.3% of cases a patent infarct-related artery was found; in 71% of patients a coronary angioplasty was performed, with stenting in 88% of cases. Procedure-related complications were infrequent. No deaths occurred during hospitalization and at 30 days; at 6 months the mortality rate was 1.3%. In-hospital reinfarction occurred in 3.8% of patients, in 4% at 30 days and in 5.3% at 6 months. The rate of any new revascularization was 2.6% at 30 days and 11% at 6 months.
  
  
  CONCLUSIONS
  Although obtained in a small observational study, our data, unlike those from previous studies, suggest that an invasive strategy after fibrinolysis in STEMI is safe and associated with low mortality and morbidity rates in the short and medium-terms.
authors.affiliation: Division of Cardiology, Cefalú Hospital, ASL 6 Palermo, Cefalú (PA), Italy. rodoraffa@tiscali.it
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Pino
authors.forename: Francesco
authors.initials: F
authors.lastname: Clemenza
authors.forename: Caterina
authors.initials: C
authors.lastname: Gandolfo
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Lo Cascio
authors.forename: Francesco
authors.initials: F
authors.lastname: Lo Giudice
authors.forename: Ubaldo
authors.initials: U
authors.lastname: Pulisano
authors.forename: Amerigo
authors.initials: A
authors.lastname: Stabile
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D006328:Cardiac Catheterization; D015331:Cohort Studies; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents