Coronary angiography after successful thrombolysis - Is the recommended time interval of 24 h an important issue?

IntroductionPercutaneous coronary intervention (PCI) is currently considered the gold-standard treatment of acute coronary syndromes with ST-segment elevation (STEMI). However, this is not the reality of many European centers, where thrombolysis is performed as primary therapy.AimsTo determine, in a STEMI population that performed successful fibrinolytic treatment, if the performance of coronary angiography after the first 24 h was associated with more hospital complications, including higher mortality, compared with its performance in the recommended time.MethodsRetrospective study, including 1065 patients with STEMI, who performed successful thrombolysis. The population was divided in three groups: A, patients who didn't undergo coronary angiography after successful thrombolysis (n = 278; 26.1%); B, patients who underwent coronary angiography in the first 24 h after successful thrombolysis (n = 127; 11.9%); and C, patients who underwent angiography after the first 24 h (n = 660; 62.0%). Groups were compared regarding their characteristics and in-hospital complications.ResultsGroups B and C had more male patients and had younger patients than group A. Group A presented higher Killip classes at admission, more severe left ventricle dysfunction and a higher number of complications during hospitalization. Logistic regression revealed that: 1) the non-performance of coronary angiography after thrombolysis was an independent predictor of in-hospital mortality; and 2) the performance of angiography after the recommended time wasn't associated with higher mortality.ConclusionsCoronary angiography after thrombolysis constitutes an important strategy, whose non-performance carries worse prognosis. The time interval currently recommended of 24 h seems clinically acceptable; however, its realization outside the recommended time doesn't seem to lead to higher mortality.