The incidence of minimal residual atherosclerotic coronary obstruction after successful intravenous thrombolytic therapy was evaluated in 799 patients with acute myocardial infarction. Minimal residual coronary obstruction (≤ 50%) was observed on selective coronary angiography performed 90 min after initiation of thrombolytic therapy in 43 patients (5.5%). In 42 other patients (5.4%), a > 50% but < 100% residual stenosis noted at 90 min demonstrated further resolution of obstruction to < 50% at an angiographic follow-up study 7 to 10 days later. Patients with minimal residual coronary obstruction were significantly younger (52 ± 10.7 versus 56.7 ± 10 years; p = 0.002) and had less multivessel coronary disease (p < 0.001), better initial left ventricular ejection fraction (54 ± 12% versus 50.2 ± 11.4%; p = 0.006) and a lower in-hospital mortality rate (1% versus 7%: p = 0.04) than did patients who had a significant (> 50%) residual coronary obstruction after intravenous thrombolysis. Long-term follow-up study of patients with a minimal coronary lesion (average 1.5 ± 0.6 years) and those with significant residual stenosis (average 1.6 ± 0.7 years) demonstrated that the incidence of death (2.4% in patients with minimal stenosis versus 3.5% in those with significant stenosis) and recurrent myocardial infarction (5% each) were similar in both groups. New strategies are needed to prevent coronary rethrombosis in patients with minimal atherosclerosis after thrombolytic therapy for acute myocardial infarction.
|Number of pages||9|
|Journal||Journal of the American College of Cardiology|
|State||Published - Jan 1 1991|
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