title: Routine invasive versus ischemia-guided strategy in patients with acute inferior ST-elevation myocardial infarction who received fibrinolytic therapy: a prospective randomized controlled pilot trial.
abstract: OBJECTIVE
  We sought to compare a routine invasive strategy of early coronary angiography and intended revascularization, with an ischemia-guided strategy in patients with acute inferior ST-elevation myocardial infarction (STEMI) who received fibrinolytic therapy.
  
  
  METHODS
  We enrolled 60 consecutive patients with acute inferior STEMI who received fibrinolytic therapy within 6 hours. Patients were randomly assigned to either a routine invasive strategy in which coronary angiography was performed within 48 hours with intended revascularization if eligible (Group A), or an ischemia-guided strategy in which catheterization was based on the presence of myocardial ischemia and viability as demonstrated by stress myocardial perfusion imaging (Group B). Patients were prospectively followed up for 6 months. The primary endpoint was a composite of cardiac death, recurrent myocardial infarction, recurrent ischemia or stroke at 6-month follow-up. Total costs per patient were calculated over 6 months.
  
  
  RESULTS
  The mean age of the whole series was 52 ± 9.8 years (15% females). The primary endpoint occurred more frequently in group A as compared to group B, however, the difference did not meet statistical significance (36.7% versus 23.3%, respectively, p > 0.05). The mean cost per patient at 6-month follow-up was significantly higher in Group A as compared to that in Group B ($4953.5 ± 3108.5 versus $2764.6 ± 2636.7, respectively, p < 0.01).
  
  
  CONCLUSIONS
  In patients presenting with inferior STEMI who received fibrinolytic therapy, a routine invasive strategy with early coronary angiography and intended revascularization, achieved a clinical outcome similar to an ischemia-guided strategy; yet, at a significantly higher cost.
authors.affiliation: Cardiology Department, Ain Shams University Hospitals, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt P.O. 11361. sesame882000@yahoo.com
authors.forename: Samah
authors.initials: S
authors.lastname: Abdul-Rahman
authors.forename: Wail
authors.initials: W
authors.lastname: Nammas
authors.forename: Adel
authors.initials: A
authors.lastname: Gamal
authors.forename: Amr
authors.initials: A
authors.lastname: Adel
authors.forename: Tarek
authors.initials: T
authors.lastname: Zaki
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003362:Cost-Benefit Analysis; D004562:Electrocardiography; D023381:Endpoint Determination; D005260:Female; D005343:Fibrinolytic Agents / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D056989:Inferior Wall Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging; D009204:Myocardial Revascularization / Q000191:economics / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents