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• W1969068963 abstract "This study sought to determine whether clinical variables can be used to identify patients at high risk of recurrent spontaneous myocardial ischemia or hemodynamic compromise during the 1st 4 days after intravenous thrombolysis for acute myocardial infarction. Of 288 patients randomly assigned to a conservative postthrombolysis strategy, 54 (19%) required urgent cardiac catheterization within 24 h; 75 (26%) underwent urgent cardiac catheterization within 4 days of admission. Of the clinical variables examined by multiple logistic regression analysis, only patient age and anterior wall myocardial infarction correlated with the need for urgent cardiac catheterization (p = 0.0016 and p = 0.017, respectively). Compared with recombinant tissue-type plasminogen activator or urokinase monotherapy, combination therapy with these agents was associated with a lower need for acute intervention during the 1st 24 h after admission, but the difference did not reach statistical significance (14% for combination therapy vs. 21 % for each agent alone, p = 0.30). Of the 75 patients undergoing urgent coronary angiography, only 39% had an occluded infarct-related artery. Emergency coronary angioplasty was performed in 49% of the patients and coronary artery bypass graft surgery was performed urgently in 3%. Despite these interventions, the need for urgent cardiac catheterization was associated with an in-hospital mortality rate of 7% (vs. 3% in the group not requiring urgent angiography, p = 0.36); mean left ventricular ejection fraction was 50.5 ± 11% (vs. 54.3 ± 10.8%, p = 0.12) and regional infarct zone wall motion was −2.68 ± 1.07 SD/chord (vs. −2.46 ± 1.19 SD/chord; p = 0.44). These data suggest that a relatively large proportion of patients treated conservatively after thrombolytic therapy require early triage to urgent coronary angiography; 2) baseline clinical characteristics are poorly predictive of the need for urgent intervention; and 3) despite ready access to facilities for aggressive intervention, the in-hospital clinical outcome of this group of patients appears to be poorer than that of patients without recurrent ischemia or hemodynamic instability." @default.
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• W1969068963 date "1991-12-01" @default.
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• W1969068963 title "Determinants of the need for early acute intervention in patients treated conservatively after thrombolytic therapy for acute myocardial infarction" @default.
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• W1969068963 doi "https://doi.org/10.1016/0735-1097(91)90490-z" @default.
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