ANALYSIS OF THE SAFETY OF BRONCHOSCOPY AFTER RECENT ACUTE MYOCARDIAL-INFARCTION

Acute myocardial infarction (AMI) is generally considered to increase the risk of flexible fiberoptic bronchoscopy (FFB). Currently, to our knowledge, no data in the literature support or challenge this concept . We conducted a retrospective chart review for the years 1986 to 1994 of 20 patients (14 men) who underwent 21 FFBs while hospitalized for an AMI. The mean age was 63.8 years (range, 38 to 83 years). Ten patie nts underwent revascularization procedures (eight coronary artery bypa ss grafting and two percutaneous transluminal coronary angioplasty) be fore FFB. The mean period between the AMI and FFB was 11.7 days (range , 1 to 30 days). Indications for FFB were pulmonary infiltrate (n=10), hemoptysis (n=6), atelectasis (n=4), and to localize a suspected bron chopleural fistula (n=1). Procedures performed included airway examina tion (21), BAL (12), transbronchial biopsy (2), endobronchial biopsy ( 3), and endobronchial brushing (4). No procedure was interrupted as a result of an adverse event, and five patients died during the same hos pitalization. Four of the deaths occurred 6 to 15 days postprocedure; 1 patient (who had active ischemia at the time of FFB) died 4 h postpr ocedure. We conclude that FFB is safe in the immediate post-AMI period as long as the patient does not have active ischemia at the time of t he procedure.