CORONARY ANGIOGRAPHY AND ANGIOPLASTY AFTER ACUTE MYOCARDIAL-INFARCTION

Purpose: To assess the data that support the use of coronary angiograp hy and angioplasty after acute myocardial infarction, that identify th e risks of these procedures, and that analyze their use and costs. Dat a Sources: English-language articles published between 1970 and June 1 995 identified through a search of the MEDLINE database. Study Selecti on: Studies that contained information about benefits, risks, use, and costs of coronary angiography and angioplasty after acute myocardial infarction. Data Extraction: Descriptive and analytic data from each s tudy were collected.Data Synthesis: The outcome for patients who have complications of myocardial infarction (such as shock) is poor. Such p atients usually undergo angiography, although the evidence that suppor ts this practice is weak. Preliminary data suggest that patients who i mmediately have angiography and angioplasty after acute myocardial inf arction have better outcomes than do patients who receive thrombolytic therapy with angioplasty only for specific indications in experienced centers. After the acute phase of myocardial infarction, patients who have noninvasive evidence of persistent or recurrent ischemia are bel ieved to benefit from angiography. In the remaining patients, however, angiography after myocardial infarction has not been shown to be bene ficial. Coronary angiography is done in 30% to 81% of patients after a cute myocardial infarction in different settings and regions; for many of these patients, the benefit is questionable. Better outcomes are n ot always associated with more frequent use of the procedure. In the U nited States, catheterizations after myocardial infarction cost approx imately $1 billion per year. Conclusions: Although many patients benef it from angiography and angioplasty after myocardial infarction, other s probably do not. Substantial resources are at stake.