Coronary angiography after successful thrombolysis - Is the recommended time interval of 24 h an important issue?

Introduction: Percutaneous coronary intervention (PCI) is currently considered the gold-standard treatment of acute coronary syndromes with ST-segment elevation (STEMI). However, this is not the reality of many European centers, where thrombolysis is performed as primary therapy. Aims: To determine, in a STEMI population that performed successful fibrinolytic treatment, if the performance of coronary angiography after the first 24 h was associated with more hospital complications, including higher mortality, compared with its performance in the recommended time. Methods: Retrospective study, including 1065 patients with STEMI, who performed successful thrombolysis. The population was divided in three groups: A, patients who didn't undergo coronary angiography after successful thrombolysis (n = 278; 26.1%); B, patients who underwent coronary angiography in the first 24 h after successful thrombolysis (n = 127; 11.9%); and C, patients who underwent angiography after the first 24 h (n = 660; 62.0%). Groups were compared regarding their characteristics and in-hospital complications. Results: Groups B and C had more male patients and had younger patients than group A. Group A presented higher Killip classes at admission, more severe left ventricle dysfunction and a higher number of complications during hospitalization. Logistic regression revealed that: 1) the non-performance of coronary angiography after thrombolysis was an independent predictor of in-hospital mortality; and 2) the performance of angiography after the recommended time wasn't associated with higher mortality. Conclusions: Coronary angiography after thrombolysis constitutes an important strategy, whose non-performance carries worse prognosis. The time interval currently recommended of 24 h seems clinically acceptable; however, its realization outside the recommended time doesn't seem to lead to higher mortality. (C) 2016 Elsevier Ireland Ltd. All rights reserved.