Background: Fibrinolysis is still used as the main method of reperfusion therapy in many hospitals. However, management of asymptomatic, post-acute ST-segment elevation myocardial infarction (STEMI) patients who were successfully reperfused with fibrinolysis, is still controversial.

Objective: To study the results of coronary angiography (CAG) and fractional flow reserve (FFR) in asymptomatic, post-acute STEMI patients who were successfully treated with fibrinolysis, and had normal post discharge exercise stress testing.

Material and Method: The authors performed CAG on all post-acute STEMI patients, who met all the following inclusion criteria, 1) history of successful fibrinolysis at referral hospital, 2) no history of recurrent or residual ischemic chest pain, 3) no clinical heart failure or significant arrhythmia, and 4) normal post-discharge EST. FFR was done if the patient had an infarct-related artery (IRA) diameter stenosis of 40% or more.

Results: Thirteen patients met all the inclusion criteria during the six months study period. All of them had residual severe stenosis in the IRA by CAG. The average degree of residual stenosis was 84.6±8.5% (range 70% to 95%). FFR was performed on all 13 patients and showed significant functional IRA stenosis in 11 patients with the average FFR value of 0.64±0.18 (range 0.22 to 0.75). All the patients who had significant FFR at the IRA received percutaneous coronary intervention (PCI). One patient with ulcerated plaque, but non-significant FFR, also received PCI.

Conclusion: Most asymptomatic, post-acute STEMI patients who were successfully reperfused with fibrinolysis and had normal post-discharge EST, still had residual severe stenosis of the IRA and significant FFR. Skipping the EST and directing the patient to CAG with FFR-guided PCI should be considered.

Keywords: Post STEMI patient, Fibrinolysis, FFR-guided PCI