[Against routine coronary angiography after myocardial infarction]. 1990

J P Delahaye, and M Gouton
Hôpital Cardiologique Louis-Pradel, Lyon.

Various arguments have been put forward to justify routine coronary arteriography after myocardial infarction. This investigation has been said to be essential to: 1) evaluate prognosis--while it has now been shown that combined data based upon coronary history, the initial clinical and electrocardiographic course and stress tests (electrocardiographic and/or isotope) carried out 10 to 20 days after the infarction have a predictive value superior to that of coronary arteriography regarding post-infarct mortality and the remaining functional capacity of the patient; 2) guide therapeutic indications--while patients evaluated as low risk on the basis of the above data, i.e. 50% of all infarction victims, would derive no benefit from myocardial revascularisation procedures; 3) obtain the best cost/efficacy ratio--while it has been shown that approaches based upon stress tests best fulfil this criterion. The authors plead for a reasoned approach in terms of the indication for post-infarction coronary arteriography, with the risk level of patients after the infarct being taken into account overall, and with case by case discussion of the usefulness of the investigation in terms of the patient's age (rarely indicated in the elderly, but also in the younger patient when free of ischemia during exercise), the coronary history (broad indications in recurrent infarctions), the initial clinical course (coronary arteriography indispensable where there is early recurrence of angina and/or severe left ventricular dysfunction with ejection fraction less than 0.45) and the results of stress tests performed 10 to 20 days after the infarct.

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009203 Myocardial Infarction NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION). Cardiovascular Stroke,Heart Attack,Myocardial Infarct,Cardiovascular Strokes,Heart Attacks,Infarct, Myocardial,Infarction, Myocardial,Infarctions, Myocardial,Infarcts, Myocardial,Myocardial Infarctions,Myocardial Infarcts,Stroke, Cardiovascular,Strokes, Cardiovascular
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D012307 Risk Factors An aspect of personal behavior or lifestyle, environmental exposure, inborn or inherited characteristic, which, based on epidemiological evidence, is known to be associated with a health-related condition considered important to prevent. Health Correlates,Risk Factor Scores,Risk Scores,Social Risk Factors,Population at Risk,Populations at Risk,Correlates, Health,Factor, Risk,Factor, Social Risk,Factors, Social Risk,Risk Factor,Risk Factor Score,Risk Factor, Social,Risk Factors, Social,Risk Score,Score, Risk,Score, Risk Factor,Social Risk Factor
D017023 Coronary Angiography Radiography of the vascular system of the heart muscle after injection of a contrast medium. Angiography, Coronary,Angiographies, Coronary,Coronary Angiographies

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