1. Impact of intravenous thrombolysis on short-term coronary revascularization rates: a meta-analysis
- Author
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Naylor, C. David and Jaglal, Susan B.
- Subjects
Angioplasty -- Usage ,Thrombolytic drugs -- Evaluation ,Coronary artery bypass -- Usage ,Heart attack -- Causes of ,Thrombosis -- Drug therapy ,Heart attack -- Drug therapy ,Coronary arteries -- Physiological aspects - Abstract
An acute myocardial infarction (MI or heart attack) is caused by the occlusion of one or more of the coronary arteries, which supply blood to the heart muscle. Coronary artery occlusion may be due to a thrombus, or blood clot, and intravenous thrombolytic drugs given to break down these clots are an important part of the therapy to reduce the death rate from heart attack. These drugs do not remove occlusive, fatty atherosclerotic plaques within coronary vessels. Consequently, after thrombolytic therapy, MI patients with atherosclerosis are routinely monitored with angiography (which allows X-ray visualization of vessels) to determine if they require surgery to enhance their coronary circulation. Surgical procedures that improve coronary blood flow are coronary artery bypass surgery (CABS) and percutaneous transluminal coronary angioplasty (PTCA). It has not been determined whether follow-up angiography and surgery, as advocated for these patients, are always justified, or simply routine. It is thought that patients with atherosclerosis who have suffered a heart attack should only undergo CABS or PTCA if their angina (chest pain) is severe and when other noninvasive tests of ischemic (inadequate oxygen supply) risk deem them necessary. To explore whether there is an increased need for CABS or PTCA after thrombolytic therapy, seven clinical trials of the two thrombolytic agents approved in North America, tissue plasminogen activator and streptokinase, were evaluated. Results revealed an 80 percent increase in CABS and PTCA procedures among thrombolytic therapy patients within six weeks of their MI, compared with controls who received conventional post-MI therapy. This increase is suggested to represent a reasonable attempt to consolidate the immediate gains from lysing occlusive thrombi in infarct-related coronary arteries, rather than indicative of unnecessary medical intervention or a negative result of thrombolytic therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)
- Published
- 1990