Routine Coronary Angiography and Revascularization after Thrombolysis-Impact on One-Year Prognosis

The most often used reperfusion strategy for patients with STEMI is still thrombolysis, but it is not the end of treatment. The aim of this paper was to show whether routine in-hospital coronary angiography and subsequent revascularization (percutane-ous or surgery) after thrombolysis improve an one-year prognosis in patients with STEMI. The study involved 155 patients, 29-79 years old, with first STEMI. They were treated with fibrinolytic, aspirin, and enoxaparin. Group I (102 patients) underwent coronary angiography on approximately the 5th day of hospitalization, then percutaneously or surgically revascularized if considered appropriate. In group II (53 patients), in-hospital angiography was not done. Mortality, reinfarction, angina and left ventricular systolic function were analyzed during one-year period. Patients in group II were older, they received clopidogrel and statin less frequently and ACE inhibitors more frequently. The groups were significantly different regarding the in-hospital (3% vs. 15%, p=0.008) and one-year mortality (2% vs. 11.1%, p=0.03). There was a numeric trend for higher frequency of reinfarction in group II (3% vs. 11.1%, p=0.06). After one year, more patients in group II had angina (2.9% vs. 13.2%, p=0.03). In hospital, the groups had similar EF (54% vs. 51.2%, ns), but after one year EF in group I was higher (55.2% vs. 47.6%, p=0.02). Multivariable analysis adjusted for age and differences in drug therapy showed that the lack of routine elective coronary angiography and revascularization is an independent predictor of one-year mortality (RR 4.7, p=0.019) and independent predictor of combined mortality, reinfarction and angina (RR 3.2, p=0.028). Routine coronary angiography and revascularization after thrombolysis improve in-hospital and one-year survival, decrease the frequency of reinfarction and angina, and improve the left ventricular function.