Angiografía del día siguiente tras fibrinólisis exitosa frente al tratamiento convencional, en el síndrome coronario agudo con elevación del segmento ST, fibrinolisado

Introduction and objectives: The introduction of new practice guidelines of the European Society of Cardiology in acute coronary syndrome with early coronary angiography (24 hours) after thrombolysis, even if it is effective without showing signs of residual ischemia in the cases where primary angioplasty is not performed, has been a challenge over the traditional approach in the Departments of Cardiology. Methods: During 2007, 2008 and the first half of 2009, 266 patients with acute myocardial infarction with ST segment elevation were treated with thrombolysis. After excluding the bailouts (41), in 94 (42%) of them, a catheterization was peformed within the first 24 hours (next day angiography) and the remaining 131 (58%) underwent a conventional strategy with a provocation test to elicit ischemia (conventional treatment). Results: In the first group, the average stay was 7.3 ± 3 days [median interquartile range: 7 (5-8)]. The incidence of fatal events per year was 3 (4%). There were no major bleeding, only 20 of them (22%) had groin hematomas larger than 2 cm. In the second group, the average stay was 10.2 ± 6.3 days [9 (6-13)], significantly higher (p <0.001). The number of fatal events per year was 7 (11%) and no statistically significant differences were observed (p = 0.52). Conclusions: Angiography performed the next day is associated with reduced length of stay compared to conventional treatment. It also seems to show a trend (not significant) of reduction in year mortality without increasing the number of bleeding complications.