Percutaneous Coronary Interventions in Patients With Acute Myocardial Infarction After Sucessful Thrombolysis

In 259 patients with acute myocardial infarction admitted to N.V. Sklifosofsky institute of urgent aid in 2003-20007 we compared efficacy of 3 strategies of treatment after successful thrombolytic therapy (TIT): percutaneous coronary intervention (PCI) because of recurrent ischemia within 5 days after thrombolytic therapy (n=66), PCI in patients with elevated risk of death according to TIMI during 12-24 hours after TLT (n=26); conservative treatment after TLT (n=167). Differences at comparison of two invasive strategies were related to the state of infarct-related artery and clinical effect. The use of PCI in patients with elevated risk of death in 12-24 hours after TLT was in all cases associated with timely provision of completed reperfusion, improvement of contractility, prevention of development of left ventricular aneurism. The use of both invasive strategies allowed to lessen rate of complications, and achieve several fold lowering of mortality. The data obtained show that for more objective and timely selection of patients for PCI after effective TLT it is expedient to use quantitative estimation of risk according to TIMI. Such approach allows without waiting for ischemia recurrence to detect patients with elevated risk and critical stenoses being in acute need of combined reperfusion.