"Watchful waiting" after thrombolysis: it's time for a re-evaluation.

On December 23, 2002, a colleague contacted me for a patient referral. The patient was a 43-year-old male who had presented to an outlying hospital the night before with an evolving inferior ST-elevation myocardial infarction (STEMI). He presented within 2 h of symptom onset and was treated with thrombolytic therapy. Clinically, he promptly reperfused (ST resolution, complete chest-pain relief), and he had only a mild elevation of cardiac enzymes. My colleague and I discussed treatment options. We reasoned that the infarct had largely been aborted and a persistent high-grade obstructive lesion was likely. For this reason, the patient was transferred that day. At catheterization, we found a subtotal occlusion of the distal right