Document Detail


Risk stratification after myocardial infarction in the thrombolytic era.
MedLine Citation:
PMID:  8879954     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Most patients with acute myocardial infarction do not receive or are ineligible for thrombolytic therapy, and thus their prognosis is worse than that of the populations studied in the major, randomized, lytic therapy trials. We need to devise a cost-effective strategy with which to appropriately stratify these patients. Simple, easily ascertained clinical variables that are evident soon after hospital admission can identify higher-risk patients, who are likely to be older and less able to adequately complete an exercise test. In some patients, nuclear imaging tests are appropriate; low-dose dobutamine echocardiography and ambulatory ECG monitoring may also have a role. Greater use of routine cardiac catheterization (with assessment of ventricular function) might be the most appropriate way to stratify patients because it may overcome some of the limitations of noninvasive testing, will clearly define high-risk patients, and may facilitate early discharge from the hospital. Left ventricular function and the patency of the infarct-related artery will be determined, and patients with left main coronary disease, significant three-vessel coronary artery disease, and two-vessel coronary disease (especially with proximal left anterior descending coronary artery involvement) will be identified. An aggressive strategy of revascularization to improve survival in appropriate patients may be employed. Greater use of routine coronary arteriography after acute myocardial infarction would inevitably lower the threshold for inappropriate, potentially risky, and expensive further interventions. We need to focus our attention on the most appropriate strategies for the management of patients whose prognosis is worse than the prognosis of those who receive lytic therapy after acute myocardial infarction.
Authors:
J D Rutherford
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in cardiology     Volume:  11     ISSN:  0268-4705     ISO Abbreviation:  Curr. Opin. Cardiol.     Publication Date:  1996 Jul 
Date Detail:
Created Date:  1997-01-17     Completed Date:  1997-01-17     Revised Date:  2006-05-04    
Medline Journal Info:
Nlm Unique ID:  8608087     Medline TA:  Curr Opin Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  428-33     Citation Subset:  IM    
Affiliation:
University of Texas Southwestern Medical Center, Dallas 75235-9047, USA.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary
Cost-Benefit Analysis
Electrocardiography
Exercise Test
Heart / radionuclide imaging
Heart Catheterization
Humans
Myocardial Infarction / diagnosis,  epidemiology*,  therapy
Prognosis
Risk Assessment
Thrombolytic Therapy*

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


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