Determining prognosis after acute myocardial infarction in the thrombolytic era

doi:10.1136/bmj.316.7134.865a

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Rescue angioplasty after failed thrombolysis may put patients at risk

Pitt Lim, Clinical lecturer,
Paul Shiels, Research fellow

Department of Clinical Pharmacology and Cardiology, Ninewells Hospital and Medical School, Dundee DD1 9SY
Cardiovascular Division, Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA

EDITOR—Beller brings to readers' attention the fact that routine invasive procedures after acute myocardial infarction offer no significant benefit over that offered by the routine practice of risk stratification with non-invasive methods.1 We are concerned, however, with the blanket statement that high risk patients should have 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 a direct complication of the procedure.2 Furthermore, this procedure fails in 20% of cases and those failed cases have a mortality of 40%. Vigorous clinical assessment is therefore necessary before a patient is classified as being at high risk. Inadequate optimisation of supportive treatment often …