Determining prognosis after acute myocardial infarction in the thrombolytic era

BMJ 1998;316:865 ( 14 March )

Letters

Determining prognosis after acute myocardial infarction in the thrombolytic era

Rescue angioplasty after failed thrombolysis may put patients at risk

Author's reply

Rescue angioplasty after failed thrombolysis may put patients at risk

The first 150 words of the full text of this article appear below.

EDITOR $---$ Beller brings to readers' attention the fact that routine invasive procedures after acute myocardial infarction offerno significant benefit over that offered by the routine practiceof risk stratification with non-invasive methods.¹ We are concerned,however, with the blanket statement that high risk patients shouldhave early angioplasty or rescue angioplasty after failed thrombolysis.This technique should be used with caution.

A meta-analysis by Ellis et al indicated a mortality of 10.6% after the procedure, either from the disease process or as adirect complication of the procedure.² Furthermore, this procedurefails in 20% of cases and those failed cases have a mortalityof 40%. Vigorous clinical assessment is therefore necessary beforea patient is classified as being at high risk. Inadequate optimisationof supportive treatment often leads to signs such as hypotensionand sinus tachycardia, which in turn predispose to further chestpain, interpreted as postinfarction angina . . . [Full text of this article]