Coronary arteriography in acute myocardial infarction
Mortality in acute myocardial infarction has decreased in the past few years. According to several reports, it now ranges from 13% to 25% in patients admitted to coronary care units.1, 2 Such reduction is primarily due to the wide use of hemodynamic monitoring,1 the prevention and effective therapy of life-threatening arrhythmias,3 the use of vasodilators to overcome pump failure,4 the clinical application of assisted circulatory devices,5 and the judicious use of surgical intervention.6 Recent experiences also suggest that the knowledge of coronary anatomy during acute myocardial infarctions may be an important asset in making appropriate therapeutic decisions.5, 7
Usually coronary arteriography is indicated in acute myocardial infarction when there is refractory pump failure or persistent chest pain. However, at our institution, we have incorporated coronary angiography as a routine test for all patients with acute myocardial infarction before discharge from the hospital.
In 315 of 410 patients admitted to the Instituto Dante Pazzanese de Cardiologia, São Paulo, for treatment of acute myocardial infarction, cine coronary arteriography and left ventriculography were performed an average of 12 days (range, 10 hours to 25 days) after onset of symptoms without any major technical complications. Contraindications for coronary angiography during acute infarction included renal failure, old age (75 years or older), cerebral vascular accident or refusal of the patient.
Normal coronary arteries were observed in four patients (1.3%). Forty-seven percent had one-vessel disease and 54% had multivessel disease. In 65% of patients, the artery corresponding to the area of infarction was totally occluded, and . . .