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Angiographic Findings After Successsful Thrombolysis in Patients with Acute Myocardial Infarction in the General Population

Osorio H, Pulido N, Vidaillet H, Reskalla S, Granada J, Marshfield Clinic, Marshfield, WI

Objective: To describe the angiographic findings among patients with Acute Myocardial Infarction (AMI) successfully reperfused with intravenous tPa in the general population.

Methods: We used the Marshfield's Clinic Cardiology Database to identify AMI cases during ~3 years. Two-hundred potential cases were analyzed. Incident cases of AMI were defined by clinical, enzymatic, ECG criteria. All the patients met clinical and electrocardiographic reperfusion criteria after tPa infusion.

Results: A total of 79 patients were enrolled consecutively. The mean age was 63±12 years and 56 (71%) were males. Hypercholesterolemia (56%), hypertension (44%), tobacco abuse (39%), diabetes (19%) and COPD (6%) were the most common associated clinical features. A coronary angiogram was performed to 76 patients (96%); either at admission or during the first week of the AMI. The left anterior descendent artery (42%) was the most commonly affected artery, followed by the right coronary artery (36%) and left circumflex (11%). In 89% of the cases the artery was occluded proximally at the mid-third. The residual percentage of stenosis was 89±10%. TIMI 0 flow was found in 18% of the cases at the time of the initial angiogram. In 40 patients (52%, a successful angiographic reperfusion (TIMI 3) was achieved.

Conclusion: Complete coronary reperfusion (TIMI 3) is achieved in ~50% of the patients after successful thrombolysis. The atherosclerotic plaque responsible for the acute coronary event seems to be bigger than preciously recognized. The suboptimal results by thrombolysis alone suggest that more aggressive therapy may be required to improve clinical outcomes.

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