الفهرس 
Acute ST-segment Elevation MyocardialOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Acute myocardial infarction (AMI) remains a public health
problem of epidemic proportions. Interestingly, in the last
decade the National Registry of Myocardial Infarction
(NRMI) have recorded a decrease in the percentage of
patients with myocardial infarction who present with ST
segment elevation (from 36% to 27%, p ≤< 0.001), while the
percentage presenting without ST segment elevation has
increased (from 45% to 63%, p ≤<0.001).
Despie of the superiority of primary PCI ,most of patients
with ST-elevation myocardial infarction present to
hospitals without percutaneous coronary intervention
(PCI) facilities and receive fibrinolysis.
Early post thrombolysis referral had been discouraged in
the past; however multiple studies were performed
comparing immediate or early angiography after
fibrinolysis versus a more conservative strategy of
deferred PCI or ischaemia-guided management showed
Recommendations
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evidence for a reduction in the risk of total mortality in
patients undergoing immediate or early PCI. with no
significant differences in the risk of stroke or major
bleeding .
These results support the current recommendation for
routine early invasive strategy in STEMI patients after
successful fibrinolysis but the best timing for referral to
invasive strategy still needs to be studied more in
randomized trials.
The aim of this work was to study the efficacy and safety
of early versus very early coronary angioplasty for
infarct related artery and hence best timing for invasive
strategy post successful thrombolysis in patients
presenting with STEMI.
The study was conducted on 60 paents who presented to the
emergency room complaining of typical anginal pain and were
diagnosed as having acute ST segment elevation myocardial
infarction. All patients were treated by streptokinase. Then
Patients with signs of successful thrombolysis were
randomized into 2 groups:
i. Group I : 30 paents were referred to invasive
Strategy aer 3 hours and within 12 hours aer
receiving successful thrombolysis (very early
group).