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By Christopher P. Cannon (Editor), Patrick T. O'Gara (Editor)

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The findings from TIMI-IIB, with the added support of the findings from the Should We Intervene Following Thrombolysis? (SWIFT) trial, and other studies, lend strong support to the notion that coronary angiography can be reserved for patients who demonstrate recurrent ischemia after thrombolysis for ST-segment elevation MI (46,47,48,49,50,51 and 52,56). In the current era of cost containment, close scrutiny of the indications for cardiac catheterization, with more strict adherence to its need in patients with documented recurrent ischemia after MI, may allow reductions in the use of cardiac procedures (and thus costs), without any loss of clinical benefit.

Association of thrombolysis medication errors with increased mortality in the Global Utilization of Streptokinase and tPA for Occluded Coronary Arteries (GUSTO)-I trial. (Data from Vorchheimer DA, Baruch L, Thompson TD, et al. North American vs. non–North American streptokinase use in GUSTO-I: impact of protocol deviation on mortality benefit of tPA. Circulation 1997;96[Suppl I]:I-535; reproduced from Cannon CP. Thrombolysis medication errors: benefits of bolus thrombolytic agents. 7% vs. 001).

N Engl J Med 1996;335:1333–1341. 46. Antman EM, Tanasijevic MJ, Thompson B, et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996;335:1342–1349. 47. Polanczyk CA, Lee TH, Cook EFD, et al. Cardiac troponin I as a predictor of major cardiac events in emergency department patients with acute chest pain. J Am Coll Cardiol 1998;32:8–14. 48. Antman EM, Sacks DB, Rifai N, et al. Time to positivity of a rapid bedside assay for cardiac-specific troponin T predicts prognosis in acute coronary syndromes: a thrombolysis in myocardial infarction (TIMI) 11A Substudy.

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Critical Pathways in Cardiology by Christopher P. Cannon (Editor), Patrick T. O'Gara (Editor)

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