From The Cardiovascular Research Institute (A.M.R., K.S.C., E.M., J.S.R.,
P.L.W., Y.C.D., C.F.L.) and the Biostatistics Center (S.W.G.) of George
Washington University, Washington, DC; the Thoraxcentrum, Rotterdam, the
Netherlands (M.L.S.); Duke University, Durham, NC (R.M.C.); the Cleveland
(Ohio) Clinic (E.J.T.); and the University Hospital Gasthuisberg, Leuven,
Belgium (F. Van de W.).
Correspondence to Allan M. Ross, MD, Director, Cardiovascular Research Institute, George Washington University, 2150 Pennsylvania Ave, NW, Suite 4-412, Washington, DC 20037.
Background—Reperfusion therapy for
myocardial infarction, understood to reduce mortality by preserving
left ventricular function, was initially expected to
provide increasing benefits over time. Surprisingly, large controlled
thrombolysis trials demonstrated maximum benefit at 4
to 6 weeks with no subsequent increased treatment advantage. Such
studies, however, compared groups by assigned treatment, not
physiological effectiveness.
Methods and Results—We calculated 2-year survival differences
among 2431 myocardial infarction patients according to early infarct
artery patency and outcome left ventricular ejection
fraction using Kaplan-Meier curves. Hazard ratios for significant
survival determinants were derived from Cox regression models. Two-year
vital status (minimum, 688 days) was determined in 2375 patients
(97.7%). A substantial mortality advantage for early complete
reperfusion (Thrombolysis in Myocardial Infarction [TIMI]
grade 3) and for preserved ejection fraction occurred beyond 30 days.
The unadjusted hazard ratio for the TIMI 3 group compared with lesser
grades at 30 days was 0.57 (95% confidence interval [CI], 0.35 to
0.94) and 30 days to
Conclusions—Successful reperfusion and myocardial salvage produce
significant mortality benefits that are amplified beyond the initial 30
days.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Extended Mortality Benefit of Early Postinfarction Reperfusion
688 days was 0.39 (95% CI, 0.22 to 0.69).
Consequently, early TIMI 3 flow was associated with approximately a 3
patient per 100 mortality reduction the first month with an additional
5 lives per 100 from 30 days to 2 years. For ejection fraction >40%
compared with 
40%, the unadjusted hazard ratio was 0.25 (95% CI,
0.16 to 0.37) at 30 days and 0.22 (95% CI, 0.15 to 0.33) after 30 days
through 2 years (lives saved, 
9 and 11 per 100, respectively).
Key Words: myocardial infarction • thrombolysis • reperfusion • follow-up studies • mortality
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