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(Circulation. 1995;91:2862-2864.)
© 1995 American Heart Association, Inc.
Articles |
Thrombolysis for Acute Myocardial Infarction
Why Is There No Extra Benefit After Hospital Discharge?
From the Department of Cardiology, University Hospital Gast- huisberg, Leuven, Belgium.
Correspondence to Frans Van de Werf, MD, PhD, Department of Cardiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium. E-mail cardio@uz.kuleuven.ac.be.
Key Words: Editorials • thrombolysis • myocardial infarction
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Introduction |
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Large-scale randomized trials in patients with acute myocardial infarction have demonstrated that thrombolytic therapy when given within 12 hours after onset of symptoms reduces hospital mortality1 2 3 4 5 6 and that this survival benefit persists.7 8 9 Early and sustained coronary artery patency with infarct size reduction, preserved left ventricular function, attenuation of left ventricular dilation, and enhanced electrical stability are thought to be the responsible mechanisms of action. On the basis of these favorable effects, one would theoretically expect survival benefits not only during the hospital stay but also afterward and, therefore, diverging survival curves between patients who received thrombolytic therapy and control patients. This, however, has not been observed.
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Long-term Follow-up in Controlled Trials of Thrombolytic Therapy |
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In all large-scale trials, the postdischarge mortality curves of treated patients and control patients run perfectly parallel for 1 to 4 years,7 8 9 10 even in subgroups of patients who were treated early after the onset of symptoms, as shown in GISSI-1.7 In the latter group, one would certainly expect substantial salvage of ischemic myocardium and significant preservation of left ventricular systolic function and therefore an extra survival benefit after hospital discharge. A meta-analysis of the long-term benefits of intravenous thrombolytic therapy in more than 40 000 patients participating in placebo-controlled trials clearly shows that the risk of death after 1 month is equal in survivors of an acute myocardial infarction whether or not thrombolytic therapy was given on admission and, surprisingly, irrespective of the time this treatment was started (Fig 1
). Of 18 826 patients who received
thrombolytic therapy within 12 hours after onset This article has been cited by other articles:
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