INDICATIONS OF CORONARY ANGIOGRAPHY AND ANGIOPLASTY DURING THE 1ST WEEK AFTER MYOCARDIAL-INFARCTION

There is little data available on the precise indications of coronary angiography and myocardial revascularisation during the first week after myocardial infarction. Mechanical complications (subacute rupture, ventricular septal defect, ruptured mitral chordae), usually require emergency surgery: when the patient's haemodynamic status permits, preoperative coronary angiography is desirable. Recurrent ischaemia may be treated by urgent coronary angiography - dilatation; nevertheless, the results of this type of procedure are associated with high mortality and morbidity and it would seem better practice to start with repeat intravenous thrombolytic therapy: coronary angiography can then be performed in a less acute situation with a view to angioplasty. Finally, in most cases of uncomplicated infarctions, functional investigations such as exercise stress testing coupled with radioisotopic methods, may be usefully performed before coronary angiography to demonstrate any residual ischaemia justifying a myocardial revascularisation procedure: under these conditions, it seems more realistic to envisage coronary angiography 8 to 10 days after the initial coronary event.