Early angiography cannot predict postthrombolytic coronary reocclusion: observations from the GUSTO angiographic study. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries
JS Reiner,
CF Lundergan,
M van den Brand,
J Boland,
MA Thompson,
J Machecourt,
A Py,
GS Pilcher,
CA Fink,
Burton JR,
et al.
Division of Cardiology, George Washington University, Washington, D.C. 20037.
OBJECTIVES. The purpose of this study was to determine whether early qualitative or quantitative angiographic features can predict reocclusion after initially successful coronary thrombolysis. BACKGROUND. Although both the benefits of early reperfusion and the consequences of subsequent reocclusion after thrombolysis for acute myocardial infarction have been well described, efforts to describe angiographic markers of lesions at high risk for reocclusion have produced conflicting results. The Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) angiographic trial provides the opportunity to examine these relations in the largest single, prospective patient cohort studied to date. METHODS. We studied 559 patients undergoing follow-up angiography at 90 min and 5 to 7 days after thrombolysis in the GUSTO trial. Patients received one of four thrombolytic regimens: 1) streptokinase with intravenous heparin; 2) streptokinase with subcutaneous heparin; 3) accelerated-dose recombinant tissue-type plasminogen activator (rt-PA) with intravenous heparin; or 4) a combination of streptokinase and conventionally dosed rt-PA with intravenous heparin. Qualitative variables examined at 90-min angiography included Thrombolysis in Myocardial Infarction (TIMI) flow grade, visible thrombus and lesion morphology. Quantitative variables included percent diameter stenosis, percent area stenosis, minimal lumen diameter and lesion length. The study contained a power > 0.85 to detect clinically important differences in percent diameter stenosis, percent area stenosis and minimal lumen diameter between the groups with subsequent reocclusion and sustained patency at the p = 0.05 level. RESULTS. At follow-up, 33 patients (5.9%) had reocclusion. The reocclusion rate for patients with early TIMI grade 2 flow was 6.3% versus 5.6% for TIMI grade 3 flow (p = NS). When the group with reocclusion was compared with the group with continued patency, there were no differences in presence of early visible thrombus, complex lesion morphology, percent diameter stenosis, percent area stenosis, minimal lumen diameter or lesion length. CONCLUSIONS. Our findings demonstrate that neither qualitative nor quantitative angiographic variables at 90 min after initiation of thrombolytic therapy can be used to predict subsequent coronary reocclusion.
This article has been cited by other articles:

|
 |

|
 |
 
R. Bugiardini, O. Manfrini, and G. M. De Ferrari
Unanswered questions for management of acute coronary syndrome: risk stratification of patients with minimal disease or normal findings on coronary angiography.
Arch Intern Med,
July 10, 2006;
166(13):
1391 - 1395.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. Bugiardini
Women, 'non-specific' chest pain, and normal or near-normal coronary angiograms are not synonymous with favourable outcome
Eur. Heart J.,
June 2, 2006;
27(12):
1387 - 1389.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Namdar, T. F. Hany, P. Koepfli, P. T. Siegrist, C. Burger, C. A. Wyss, T. F. Luscher, G. K. von Schulthess, and P. A. Kaufmann
Integrated PET/CT for the Assessment of Coronary Artery Disease: A Feasibility Study
J. Nucl. Med.,
June 1, 2005;
46(6):
930 - 935.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. C. Silva, C. E. Rochitte, J. S. Junior, J. Tsutsui, J. Andrade, E. E. Martinez, P. J. Moffa, J. C. Menegheti, R. Kalil-Filho, J. F. Ramires, et al.
Late coronary artery recanalization effects on left ventricular remodelling and contractility by magnetic resonance imaging
Eur. Heart J.,
January 1, 2005;
26(1):
36 - 43.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
B. De Bruyne, N. H.J. Pijls, J. Bartunek, K. Kulecki, J.-W. Bech, H. De Winter, P. Van Crombrugge, G. R. Heyndrickx, and W. Wijns
Fractional Flow Reserve in Patients With Prior Myocardial Infarction
Circulation,
July 10, 2001;
104(2):
157 - 162.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. A. Barrabes, D. Garcia-Dorado, M. A. Gonzalez, M. Ruiz-Meana, J. Solares, Y. Puigfel, and J. Soler-Soler
Regional expansion during myocardial ischemia predicts ventricular fibrillation and coronary reocclusion
Am J Physiol Heart Circ Physiol,
May 1, 1998;
274(5):
H1767 - H1775.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. W. Smalling and H. V. Anderson
Pathophysiological Insight Into the Possible Optimal Therapies for Acute Myocardial Infarction and Unstable Angina
Circulation,
January 13, 1998;
97(1):
10 - 11.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. W. van't Hof, F. Zijlstra, M.-J. de Boer, Ay Lee Liem, J. C. Hoorntje, H. Suryapranata, and H. Suryapranata
Patency and Reinfarction in Late-Entry Myocardial Infarct Patients Treated with Reperfusion Therapy
Angiology,
March 1, 1997;
48(3):
215 - 222.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
E. J. Topol and S. E. Nissen
Our Preoccupation With Coronary Luminology : The Dissociation Between Clinical and Angiographic Findings in Ischemic Heart Disease
Circulation,
October 15, 1995;
92(8):
2333 - 2342.
[Abstract]
[Full Text]
|
 |
|
|