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September 3, 1987New England Journal of Medicine

A Randomized Trial of Immediate versus Delayed Elective Angioplasty after Intravenous Tissue Plasminogen Activator in Acute Myocardial Infarction

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Why the study?

Does immediate angioplasty improve angiographic and functional outcomes compared to delayed elective angioplasty in patients with acute myocardial infarction after successful thrombolysis?

Population

197 patients with acute myocardial infarction who had successful thrombolysis with intravenous tissue…

Comparison

Immediate coronary angioplasty (n=99) vs Deferred coronary angioplasty at 7 to 10 days…

Design

RCT, randomly assigned

Follow-up

7 to 10 days

Authors

ETEric J. TopolRCRobert M. CaliffBGBarry S. George

Discussion

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Overview

Immediate angioplasty offers no advantage over elective after successful thrombolysis; challenges routine immediate intervention in post-MI care.

Structured PICO

Does immediate angioplasty improve angiographic and functional outcomes compared to delayed elective angioplasty in patients with acute myocardial infarction after successful thrombolysis?

P
Population
197 patients with acute myocardial infarction who had successful thrombolysis with intravenous tissue plasminogen activator (tPA) and a patent but severely stenotic vessel suitable for angioplasty (from an initial cohort of 386 patients).
I
Intervention
Immediate coronary angioplasty (n=99)
C
Comparator
Deferred (elective) coronary angioplasty at 7 to 10 days after infarction (n=98)
O
Outcome
Incidence of reocclusion and global left ventricular functionsurrogate

In patients with acute myocardial infarction and successful thrombolysis, immediate angioplasty offers no clear advantage over delayed elective angioplasty regarding reocclusion or left ventricular function.

Cite This Study

Topol et al. (1987) studied this question.

synapsesocial.com/papers/6a80deecadafcd383664675dhttps://doi.org/10.1056/nejm198709033171001
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1A randomized, placebo-controlled trial of intravenous recombinant tissue-type plasminogen activator and emergency coronary angioplasty in patients with acute myocardial infarction.1987 · 123 citations
  2. 2Percutaneous transluminal coronary angioplasty immediately after intracoronary streptolysis of transmural myocardial infarction.1982 · 309 citations
  3. 3The Thrombolysis in Myocardial Infarction (TIMI) Trial1985 · 3,191 citations
  4. 4Incomplete lysis of thrombus in the moderate underlying atherosclerotic lesion during intracoronary infusion of streptokinase for acute myocardial infarction: quantitative angiographic observations.1986 · 248 citations
  5. 5Rethrombosis after reperfusion with streptokinase: importance of geometry of residual lesions.1984 · 321 citations