Circulation, Vol 89, 61-67, Copyright © 1994 by American Heart Association
HD White, DB Cross, JM Elliott, RM Norris and TW Yee
BACKGROUND: After thrombolytic therapy, long-term patency of the
infarct-related artery may reduce arrhythmias, limit ventricular
dilatation, and provide collaterals to another infarct zone if further
infarction occurs. However, independent long-term prognostic value of
infarct artery patency has not been shown. METHODS AND RESULTS: We followed
312 patients with first myocardial infarction treated < 4 hours after
pain onset with thrombolysis (streptokinase [n = 188] or recombinant
tissue-type plasminogen activator [n = 124]). At 28 +/- 11 days, cardiac
catheterization was performed. Flow of the infarct- related artery was
assessed by the TIMI scoring system, and a scoring system relating coronary
stenoses and flow to the amount of myocardium supplied was also used.
Follow-up was for 39 +/- 13 months. Cardiac death occurred in 5.8% of
patients, and there were two noncardiac deaths. Revascularization was
performed in 11.5% of patients. On univariate and multivariate analysis,
ventricular function (ejection fraction, P = .006 and .02, or end-systolic
volume index, P = .01 and .06) was the most important prognostic factor.
Patency of the infarct- related artery measured as TIMI 3 flow was
marginally significant on univariate analysis (P = .08) but not on
multivariate analysis (P = .2). Patency was an independent prognostic
factor in univariate and multivariate analysis when measured as an
occlusion score (amount of myocardium supplied by an occluded artery, P =
.01 and < .05). When the ejection fraction was > or = 50%, only
occluded arteries supplying > 25% of the left ventricle affected
prognosis adversely. If the ejection fraction was < 50%, occluded
arteries supplying < 25% of myocardium also adversely affected
prognosis. Treadmill exercise duration 4 weeks after infarction was the
only other prognostic factor identified. CONCLUSIONS: Ventricular function
and infarct-related artery patency are independent prognostic factors after
thrombolytic therapy for acute myocardial infarction.
ARTICLES
Long-term prognostic importance of patency of the infarct-related coronary artery after thrombolytic therapy for acute myocardial infarction
Cardiovascular Research, Green Lane Hospital, Auckland, New Zealand.
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