Some patients present with atypical symptoms, or signs, which preclude immediate administration of fibrinolytic therapy, because of the uncertainty that an MI is evolving. Emergency angiography, with subsequent primary angioplasty upon identification of a culprit artery, may afford an immediate diagnosis and therapy and eliminate the risk of exposing the patient to an unneeded and potentially dangerous therapy. McCullough et al. reported on a randomized study of early triage angiography vs conservative therapy in 197 patients ineligible for lytic therapy (102). Revascularization was performed in 52 and 35% of the two groups, respectively. The early angiography group had a significantly lower rate of recurrent ischemia (14 vs 33%) and markedly reduced hospital stay.
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