This paper reviews the published data on the use of coronary angiography after acute myocardial infarction (AMI) and the use of angioplasty. Data were obtained from literature listed in MEDLINE records from January 1970 through June 1995 and articles listed in bibliographies of that literature.

The benefits of angiography undertaken at different times after AMI, with and without thrombolytic therapy, are reviewed. Additionally, the complications of MI that may increase the benefit of angiography and revascularization are discussed (persistent chest pain, mitral regurgitation, ventricular septal defect, shock, and persistent pulmonary edema).

Other factors are associated with worse outcomes after MI (left ventricular function, increased age, presence of three-vessel coronary disease, previous myocardial infarction, non-Q-wave infarction, female sex, history of smoking, and presence of diabetes). However, no widely used scale is available to summarize risk factors and to predict complications of angiography or benefits of revascularization. In general, patients whose outcomes are predicted to be worse can generally be expected to respond better to aggressive intervention.

(Note: This review article does not discuss the issue of race, but it is relevant to understanding the implications of the racial differences in angiography and revascularization procedure rates that have been demonstrated in other studies.)