Circulation, Vol 79, 292-303, Copyright © 1989 by American Heart Association
J Ross Jr, EA Gilpin, EB Madsen, H Henning, P Nicod, H Dittrich, R Engler, J Rittelmeyer, SC Smith Jr and C Viquerat
It is important to select patients in the convalescent phase of acute
myocardial infarction in whom knowledge of coronary anatomy may identify
those potentially suitable for intervention aimed at improving prognosis.
However, differing guidelines have been proposed, and by applying some of
these guidelines to our large database of patients after acute myocardial
infarction, several problem areas were identified. These include lack of
considering patients with resting ischemia beyond day 5 of hospitalization,
management of patients with reduced ventricular function or patients not
exercise tested, and the role of coronary angiography in the elderly. Based
on this experience and further analysis in 1,848 patients surviving beyond
day 5 of hospitalization, a modified decision scheme for coronary
angiography was developed and then tested in a second population (n = 780).
In the new scheme, patients over 75 years of age are considered
individually. Those under 75 years of age with severe resting ischemia in
the hospital at any time beyond the first 24 hours (18% mortality between
day 6 and year 1), and hospital survivors with a history of previous
myocardial infarction and clinical or radiographic signs of left
ventricular failure in the hospital (25% 1-year mortality after discharge),
are recommended for coronary angiography. Among the remaining patients,
some will perform an exercise test, and those with an ischemic response or
poor workload (11% 1-year mortality) are also assigned to coronary
angiography. When an exercise test is not performed, a resting radionuclide
left ventricular ejection fraction is recommended, and coronary angiography
is considered if the value lies between 0.20 and 0.44 (12% 1-year
mortality). This relatively simple scheme does not make general
recommendations in the elderly, considers patients with in-hospital left
ventricular failure or reduced left ventricular function or both, and
approaches the problem of patients who do not perform an exercise test.
This general approach would avoid early coronary angiography in patients
with an average 1-year mortality risk after discharge of 3% and recommend
coronary angiography in those at increased risk (average mortality rate,
16%) who make up about 55% of this population under 75 years of age.
ARTICLES
A decision scheme for coronary angiography after acute myocardial infarction
Division of Cardiology, University of California, San Diego, La Jolla 92093.
This article has been cited by other articles:
 |
|
 |
|
  Writing Committee Members, E. M. Antman, D. T. Anbe, P. W. Armstrong, E. R. Bates, L. A. Green, M. Hand, J. S. Hochman, H. M. Krumholz, F. G. Kushner, et al. ACC/AHA guidelines for the management of patients with ST-Elevation myocardial infarction--executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction) J. Am. Coll. Cardiol., August 4, 2004; 44(3): 671 - 719. [Full Text] [PDF]
|
|
|
|
 |
|
 E. M. Antman, D. T. Anbe, P. W. Armstrong, E. R. Bates, L. A. Green, M. Hand, J. S. Hochman, H. M. Krumholz, F. G. Kushner, G. A. Lamas, et al. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) Circulation, August 3, 2004; 110(5): 588 - 636. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Bigi, L. Cortigiani, D. Gregori, B. De Chiara, and C. Fiorentini Exercise versus recovery electrocardiography in predicting mortality in patients with uncomplicated myocardial infarction Eur. Heart J., April 1, 2004; 25(7): 558 - 564. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
ReneG. Favaloro Surgical treatment of acute myocardial infarction J. Am. Coll. Cardiol., April 1, 2000; 35(5_Suppl_B): 18B - 24B. [PDF]
|
|
|
|
|
|
P. J. Scanlon, D. P. Faxon, A.-M. Audet, B. Carabello, G. J. Dehmer, K. A. Eagle, R. D. Legako, D. F. Leon, J. A. Murray, S. E. Nissen, et al. ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1756 - 1824. [Full Text] [PDF]
|
|
|
|
 |
|
 D. W. Bates, E. Miller, S. J. Bernstein, P. J. Hauptman, and L. L. Leape Coronary Angiography and Angioplasty after Acute Myocardial Infarction Ann Intern Med, April 1, 1997; 126(7): 539 - 550. [Abstract] [Full Text]
|
|
|
|
|
|
L. Tavazzi and A. Volpi Remarks About Postinfarction Prognosis in Light of the Experience With the Gruppo Italiano per lo Studio della Sopravvivenza nell' Infarto Miocardico (GISSI) Trials Circulation, March 4, 1997; 95(5): 1341 - 1345. [Full Text]
|
|
|
|
|
|
K. M. Kuntz, J. Tsevat, L. Goldman, and M. C. Weinstein Cost-effectiveness of Routine Coronary Angiography After Acute Myocardial Infarction Circulation, September 1, 1996; 94(5): 957 - 965. [Abstract] [Full Text]
|
|