title: Coronary angiography after successful thrombolysis - Is the recommended time interval of 24h an important issue?
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) is currently considered the gold-standard treatment of acute coronary syndromes with ST-segment elevation (STEMI). However, this is not the reality of many European centers, where thrombolysis is performed as primary therapy.
  
  
  OBJECTIVE
  To determine, in a STEMI population that performed successful fibrinolytic treatment, if the performance of coronary angiography after the first 24h was associated with more hospital complications, including higher mortality, compared with its performance in the recommended time.
  
  
  METHODS
  Retrospective study, including 1065 patients with STEMI, who performed successful thrombolysis. The population was divided in three groups: A, patients who didn't undergo coronary angiography after successful thrombolysis (n=278; 26.1%); B, patients who underwent coronary angiography in the first 24h after successful thrombolysis (n=127; 11.9%); and C, patients who underwent angiography after the first 24h (n=660; 62.0%). Groups were compared regarding their characteristics and in-hospital complications.
  
  
  RESULTS
  Groups B and C had more male patients and had younger patients than group A. Group A presented higher Killip classes at admission, more severe left ventricle dysfunction and a higher number of complications during hospitalization. Logistic regression revealed that: 1) the non-performance of coronary angiography after thrombolysis was an independent predictor of in-hospital mortality; and 2) the performance of angiography after the recommended time wasn't associated with higher mortality.
  
  
  CONCLUSIONS
  Coronary angiography after thrombolysis constitutes an important strategy, whose non-performance carries worse prognosis. The time interval currently recommended of 24h seems clinically acceptable; however, its realization outside the recommended time doesn't seem to lead to higher mortality.
authors: Hospital Santarém, Santarém, Portugal. Electronic address: ccatiasofia@sapo.pt.
authors: Cátia
authors: C
authors: Costa
authors: Hospital Santarém, Santarém, Portugal.
authors: David
authors: D
authors: Durão
authors: Sociedade Portuguesa de Cardiologia, Delegação de Coimbra, Portugal.
authors: Adriana
authors: A
authors: Belo
authors: Hospital Santarém, Santarém, Portugal.
authors: Kevin
authors: K
authors: Domingues
authors: Hospital Santarém, Santarém, Portugal.
authors: Beatriz
authors: B
authors: Santos
authors: Hospital Santarém, Santarém, Portugal.
authors: Margarida
authors: M
authors: Leal
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute coronary syndromes with ST-segment elevation; Coronary angiography; Coronary artery disease; Thrombolysis