Coronary Arteriography Should Not Be Routinely Used Postinfarction in Patients Having Received Thrombolytic Therapy

The use of thrombolytic agents in the context of an acute myocardial infarction has resulted in a significant decrease in postinfarction mortality. However, at this time, little information supporting the routine use of invasive diagnostic and therapeutic interventions in all patients with acute myocardial infarction having received thrombolytic agents is available. Rather, the available data support a conservative strategy, which recommends the judicious use of these techniques in patients with evidence of clinical ongoing ischemia or in patients with a positive predischarge exercise stress test. Several potential explanations have been identified, the most important being the instability of the plaque in the early postinfarction period and the importance of functional capacity as an independent risk factor for subsequent morbidity and mortality. Until studies showing that routine coronary arteriography improves the prognosis of patients with negative predischarge exercise tests, we believe that it will be difficult to justify routine coronary arteriography even in patients with left ventricular dysfunction postinfarction. This more conservative approach should result in significant savings and a more rational use of available resources.