Coronary recanalization in acute myocardial infarction: immediate results and potential risks

Between September 1980 and March 1982, 83 patients were catheterized during the acute phase of their myocardial infarction with the intention to recanalize their infarct-related vessel (IRV); of these 83, 30 participated in a randomized study. Five patients died during the catheterization procedure, two as a result of cardiogenic shock, two of migration of thrombotic material and one of possible heart rupture after a successful recanalization. In 15 patients the IR V was found to be patent at the first coronary injection. In the remaining 64 patients with an occluded IRV, 41 arteries were successfully recanalized. Of the surviving patients who underwent an attempt at recanalization, 29 had non-fatal complications which required treatment (ventricular fibrillation, ventricular tachycardia or ventricular premature beats, bradycardia, hypotension, artrioventricular block, atrial fibrillation). The complications were predominantly observed in hypotensive patients during angiography after recanalization had been accomplished. Of the 41 successful recanalizations, complications occurred in 20. Of all recanalized right coronary arteries, complications took place in 81%, of the left circumflex arteries in 25% and of the left anterior descending arteries in 24%. In conclusion, catheterization and attempts at recanalization of occluded arteries impose a substantial risk of fatal and non-fatal complications. These occur in particular during the first angiogram after the re-opening of an occluded right coronary artery. These observations lead to the following recommendations: (1) streptokinase infusion should not be considered before the circulation is adequately supported: (2) lidocaine and nifedipine should be administered prophylactically before the attempt at recanalization; (3) a non-ionic contrast medium should be used for angiography.