Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 132

Within 30 days, recurrent infarction or ischemia occurs in ~10–15% of patients treated with fibrinolytic therapy, vs. <4% of patients treated with PCI (less so with stenting, ~2%).^26,44,45 Recurrent infarction is usually due to reocclusion and is also called “infarct extension,” which is different from “infarct expansion” (LV remodeling).

It is diagnosed based on clinical grounds, ECG, and a reincrease of a downtrending troponin by >20%.

Treatment – Escalate β-blockers, NTG, and readminister anticoagulants. Emergent PCI is indicated in STEMI or hemodynamic instability. Otherwise, a non-urgent coronary angiogram is usually performed. For recurrent ST elevation, the fibrin-specific fibrinolytics may be (re-)administered if PCI cannot be performed in a timely fashion.