Coronary arteriography in acute myocardial infarction.

Sao Paulo, Brazil Morta l i ty in acute myocardia l infarction has decreased in the past few years. According to several reports, it now ranges f rom 13% to 25% in pat ients admi t t ed to coronary care uni ts . 1 , 2 Such reduct ion is pr imari ly d u e to the wide use of hemodynamic monitor ing, 1 the prevent ion a n d effective therapy of l i fe-threatening a r rhy thmias , 3 the use of vasodilators to overcome p u m p failure, the clinical application of assisted circulatory devices, a n d the judicious use of surgical intervention. Recent experiences also suggest tha t t he knowledge of coronary a n a t o m y dur ing acute myocardia l infarctions m a y be an impor tan t asset in mak ing appropr ia te therapeut ic decisions. , 7 Usually coronary ar ter iography is indicated in acute myocardial infarct ion when there is refractory p u m p failure or persistent chest pain. However, at our inst i tut ion, we have incorpora ted coronary angiography as a rout ine test for all pat ients with acute myocardial infarct ion before discharge f rom the hospital. In 315 of 410 pat ients admi t t ed to the Inst i tuto D a n t e Pazzanese de Cardiologia, Sao Paulo, for t rea tment of acute myocardia l infarction, cine coronary ar ter iography a n d left ventr iculography were performed an average of 12 days (range, 10 hours to 25 days) af ter onset of symptoms without any