Ellis et al. (123) randomized 87 patients treated with thrombolysis who had a negative noninvasive risk stratification workup to medical therapy or coronary angioplasty (4-14 d). After a 12-mo follow-up, survival free of MI was 97.8% in patients who did not receive PTCA compared to 90.5% in patients (p = 0.07). Mark et al. (124) compared the use of angiography, angioplasty, and survival rates of patients enrolled in GUSTO-1 from the U.S. and Canada. The rate of coronary angiography was 72 vs 25%, coronary angioplasty 29 vs 11% and 1-yr survival rate 90.7 vs 90.3% in the U.S. vs Canada, respectively. In the Survival and Ventricular Enlargement (SAVE) trial, 31% compared with 12% of American vs Canadian patients underwent coronary revascularization. The 1-yr mortality rates, however, were virtually identical (11%) (125). Results were similar in 240,989 patients surveyed in 1073 U.S. hospitals from 1990-1993 (126). The indications for cardiac catheterization after MI adapted from ACC/AHA guidelines are illustrated in Table 8.
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