(Circulation. 1995;92:1110-1116.)
© 1995 American Heart Association, Inc.
Articles |
Benefit of Thrombolytic Therapy Is Sustained Throughout Five Years and Is Related to TIMI Perfusion Grade 3 But Not Grade 2 Flow at Discharge
From the Thoraxcenter, Erasmus University, Rotterdam, the Netherlands (T.L., M.L.S., G.A.V.), University of Leuven (Belgium) (F.V., M.V.), and Medisch Centrum Alkmaar, Netherlands.
Correspondence to Maarten L. Simoons, MD, Thoraxcenter, BD 434, Erasmus University, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
Background Long-term follow-up in patients treated with thrombolysis for acute myocardial infarction thus far has been reported in a few studies only, and no long-term follow-up is available for patients who underwent additional percutaneous transluminal coronary angioplasty (PTCA). This report describes 5-year survival as collected in patients who received placebo, recombinant tissue plasminogen activator (rTPA), or rTPA with additional immediate PTCA in two European Cooperative Study Group trials. Determinants for long-term survival were assessed in 1043 patients discharged alive.
Methods and Results Five-year follow-up information on mortality was collected. Hospital mortality was lower after rTPA than placebo (2.5% versus 5.7%, P=.04) and higher after rTPA with immediate PTCA compared with rTPA without additional intervention (6.0% versus 2.2%, P=.07). Of the 1043 hospital survivors, data were available for 923 patients, of whom 109 died. In the placebo group, mortality after hospital discharge was 10.7% versus 11.0% in the comparative rTPA group. The patients treated with rTPA and immediate PTCA had a mortality rate of 10.5% versus 8.9% in the rTPA group without PTCA (all P=NS). Significant determinants of mortality in multivariate proportional hazards analysis were enzymatic infarct size, indicators of residual left ventricular function, number of diseased vessels and TIMI perfusion grade at discharge. Patients with TIMI grade 2 flow had mortality rates similar to those with TIMI flow grades 0 and 1, while prognosis was better in patients with TIMI flow grade 3.
Conclusions The initial in-hospital benefit of thrombolysis with intravenous rTPA is maintained throughout 5 years, with no early or late beneficial effect of systematic immediate PTCA. Enzymatic infarct size, left ventricular function, and extent of coronary artery disease are predictors for long-term survival. TIMI perfusion grade 2 at discharge should be considered as an inadequate result of therapy.
Key Words: thrombolysis • infarction • angioplasty
This article has been cited by other articles:
 |
|
 |
|
  G. Ndrepepa, J. Mehilli, S. Schulz, R. Iijima, D. Keta, R. A. Byrne, J. Pache, M. Seyfarth, A. Schomig, and A. Kastrati Prognostic Significance of Epicardial Blood Flow Before and After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndromes J. Am. Coll. Cardiol., August 12, 2008; 52(7): 512 - 517. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Ndrepepa, A. Kastrati, M. Schwaiger, J. Mehilli, C. Markwardt, A. Dibra, J. Dirschinger, and A. Schomig Relationship Between Residual Blood Flow in the Infarct-Related Artery and Scintigraphic Infarct Size, Myocardial Salvage, and Functional Recovery in Patients with Acute Myocardial Infarction J. Nucl. Med., November 1, 2005; 46(11): 1782 - 1788. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Heggunje, K. J. Harjai, G. W. Stone, R. H. Mehta, D. L. Marsalese, J. A. Boura, W. W. O'Neill, and C. L. Grines Procedural success versus clinical risk status in determining discharge of patients after primary angioplasty for acute myocardial infarction J. Am. Coll. Cardiol., October 6, 2004; 44(7): 1400 - 1407. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Bonnemeier, U. K.H. Wiegand, F. Bode, F. Hartmann, V. Kurowski, H. A. Katus, and G. Richardt Impact of Infarct-Related Artery Flow on QT Dynamicity in Patients Undergoing Direct Percutaneous Coronary Intervention for Acute Myocardial Infarction Circulation, December 16, 2003; 108(24): 2979 - 2986. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Bonnemeier, U. K.H. Wiegand, J. Friedlbinder, S. Schulenburg, F. Hartmann, F. Bode, H. A. Katus, and G. Richardt Reflex Cardiac Activity in Ischemia and Reperfusion: Heart Rate Turbulence in Patients Undergoing Direct Percutaneous Coronary Intervention for Acute Myocardial Infarction Circulation, August 26, 2003; 108(8): 958 - 964. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. L. Dauerman and B. E. Sobel Synergistic treatment of ST-segmentelevation myocardial infarction with pharmacoinvasive recanalization J. Am. Coll. Cardiol., August 20, 2003; 42(4): 646 - 651. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A A Awad-Elkarim, J P Bagger, C J Albers, J S Skinner, P C Adams, and R J C Hall A prospective study of long term prognosis in young myocardial infarction survivors: the prognostic value of angiography and exercise testing Heart, August 1, 2003; 89(8): 843 - 847. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Inverso Combination Glycoprotein IIb/IIIa Receptor Antagonists With Thrombolytics in Acute Myocardial Infarction Journal of Pharmacy Practice, August 1, 2002; 15(4): 344 - 355. [Abstract] [PDF]
|
|
|
|
 |
|
 T. Matsusaka, N. Hasebe, Y.-T. Jin, J. Kawabe, and K. Kikuchi Magnesium reduces myocardial infarct size via enhancement of adenosine mechanism in rabbits Cardiovasc Res, June 1, 2002; 54(3): 568 - 575. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A H Gershlick The acute management of myocardial infarction Br. Med. Bull., October 1, 2001; 59(1): 89 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Van de Werf New aspects of pharmacological reperfusion: from macro- to microlysis Eur. Heart J. Suppl., June 1, 2001; 3(suppl_C): C62 - C68. [Abstract] [PDF]
|
|
|
|
|
|
H. Oxenham and N. Sharpe Angiotensin-converting enzyme inhibitor treatment after myocardial infarction: A selective approach for maximum benefit J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2054 - 2055. [Full Text] [PDF]
|
|
|
|
|
|
K. S. Coyne, C. F. Lundergan, D. Boyle, S. W. Greenhouse, Y. C. Draoui, P. Walker, A. M. Ross, and f. t. G.-I A. S. Investigators Relationship of Infarct Artery Patency and Left Ventricular Ejection Fraction to Health-Related Quality of Life After Myocardial Infarction : The GUSTO-I Angiographic Study Experience Circulation, September 12, 2000; 102(11): 1245 - 1251. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K. French, T. A. Hyde, I. T. Straznicky, J. Andrews, M. Lund, D. J. Amos, A. Zambanini, C. J. Ellis, B. J. Webber, S. C. McLaughlin, et al. Relationship between corrected TIMI frame counts at three weeks and late survival after myocardial infarction J. Am. Coll. Cardiol., May 1, 2000; 35(6): 1516 - 1524. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
ReneG. Favaloro Surgical treatment of acute myocardial infarction J. Am. Coll. Cardiol., April 1, 2000; 35(5_Suppl_B): 18B - 24B. [PDF]
|
|
|
|
|
|
J. K. French, T. A. Hyde, H. Patel, D. J. Amos, S. C. McLaughlin, B. J. Webber, and H. D. White Survival 12 years after randomization to streptokinase: the influence of thrombolysis in myocardial infarction flow at three to four weeks J. Am. Coll. Cardiol., July 1, 1999; 34(1): 62 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Gottlieb, V. Boyko, D. Harpaz, H. Hod, M. Cohen, L. Mandelzweig, Z. Khoury, S. Stern, S. Behar, and for the Israeli Thrombolytic Survey Group Long-term (three-year) prognosis of patients treated with reperfusion or conservatively after acute myocardial infarction J. Am. Coll. Cardiol., July 1, 1999; 34(1): 70 - 82. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Faraggi, G Montalescot, L Sarda, J F Heintz, D Doumit, G Drobinski, I Sotirov, D Le Guludec, and D Thomas Spontaneous late improvement of myocardial viability in the chronic infarct zone is possible, depending on persistent TIMI 3 flow and a low grade stenosis of the infarct artery Heart, April 1, 1999; 81(4): 424 - 430. [Abstract] [Full Text]
|
|
|
|
|
|
D. Poldermans, P. M. Fioretti, E. Boersma, J. J. Bax, I. R. Thomson, J. R. T. C. Roelandt, and M. L. Simoons Long-Term Prognostic Value of Dobutamine-Atropine Stress Echocardiography in 1737 Patients With Known or Suspected Coronary Artery Disease : A Single-Center Experience Circulation, February 16, 1999; 99(6): 757 - 762. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Pislaru, C. Pislaru, M. Szilard, J. Arnout, and F. Van de Werf In vivo effects of contrast media on coronary thrombolysis J. Am. Coll. Cardiol., October 1, 1998; 32(4): 1102 - 1108. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. F. Lundergan, J. S. Reiner, W. F. McCarthy, K. S. Coyne, R. M. Califf, A. M. Ross, and for the GUSTO-I Angiographic Investigators Clinical predictors of early infarct-related artery patency following thrombolytic therapy: importance of body weight, smoking history, infarct-related artery and choice of thrombolytic regimen: the GUSTO-I experience J. Am. Coll. Cardiol., September 1, 1998; 32(3): 641 - 647. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Baigent, R. Collins, P. Appleby, S. Parish, P. Sleight, and R. Peto ISIS-2: 10 year survival among patients with suspected acute myocardial infarction in randomised comparison of intravenous streptokinase, oral aspirin, both, or neither BMJ, May 2, 1998; 316(7141): 1337 - 1343. [Abstract] [Full Text]
|
|
|
|
|
|
A. M. Ross, K. S. Coyne, E. Moreyra, J. S. Reiner, S. W. Greenhouse, P. L. Walker, M. L. Simoons, Y. C. Draoui, R. M. Califf, E. J. Topol, et al. Extended Mortality Benefit of Early Postinfarction Reperfusion Circulation, April 28, 1998; 97(16): 1549 - 1556. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Miida, H. Otsuka, A. Tsuchiya, and M. Okada Plasma lipoprotein profiles change significantly during cardiac catheterization Clin. Chem., March 1, 1998; 44(3): 517 - 521. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Carrozza Jr and D. S. Baim Keeping the Open Artery Open : Is Stenting the Answer? Circulation, November 4, 1997; 96(9): 2762 - 2764. [Full Text]
|
|