Document Detail


Nonemergent cardiac catheterization and risk-stratified revascularization following thrombolytic therapy for acute myocardial infarction. A critical analysis of therapy in the community setting. University of North Carolina Cardiology Consortium.
MedLine Citation:
PMID:  2525898     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We evaluated a strategy for administering thrombolytic therapy without emergent cardiac catheterization to patients with acute myocardial infarction in community hospitals. Fifty-nine patients were treated with intravenous streptokinase and heparin, and referred for elective catheterization. Angioplasty or bypass surgery was performed only in patients judged to be at risk for reinfarction. One or more predetermined criteria for infarct segment viability were present in 47 (80%) of 59 patients. Angina recurred in 24 patients and enzyme-positive reinfarction in 9 patients, but only 2 patients developed new Q waves or a creatine kinase rise to over twice the normal value. Of 18 patients judged to be at low risk for reinfarction, only 1 required urgent angioplasty or bypass surgery. Fourteen-day mortality was 7% and infarct vessel patency was 94%. These data indicate that physicians in small community hospitals with a close relationship to a referral center and with a carefully designed protocol can administer thrombolytic therapy safely and effectively. By subsequent stratification of patients according to the risk of recurrent infarction, 22% of patients eligible for revascularization were spared urgent angioplasty or bypass surgery.
Authors:
W W Rowe; R J Simpson; D A Tate; P W Willis; T C Nichols; J W Noneman; L S Gettes
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Archives of internal medicine     Volume:  149     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  1989 Jul 
Date Detail:
Created Date:  1989-08-10     Completed Date:  1989-08-10     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1611-7     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, University of North Carolina, Chapel Hill 27599.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon
Coronary Artery Bypass
Echocardiography
Female
Heart Catheterization*
Heparin / therapeutic use
Humans
Male
Middle Aged
Myocardial Infarction / mortality,  physiopathology,  therapy*
Recurrence
Risk
Streptokinase / adverse effects,  therapeutic use*
Grant Support
ID/Acronym/Agency:
HL-26309/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
9005-49-6/Heparin; EC 3.4.-/Streptokinase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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