Document Detail

Long-term prognostic importance of patency of the infarct-related coronary artery after thrombolytic therapy for acute myocardial infarction.
MedLine Citation:
PMID:  8281696     Owner:  NLM     Status:  MEDLINE    
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.
H D White; D B Cross; J M Elliott; R M Norris; T W Yee
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  89     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1994 Jan 
Date Detail:
Created Date:  1994-02-17     Completed Date:  1994-02-17     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  61-7     Citation Subset:  AIM; IM    
Cardiovascular Research, Green Lane Hospital, Auckland, New Zealand.
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MeSH Terms
Coronary Vessels / physiopathology*
Follow-Up Studies
Heart Catheterization
Middle Aged
Multivariate Analysis
Myocardial Infarction / drug therapy*,  epidemiology,  physiopathology
Streptokinase / therapeutic use*
Thrombolytic Therapy*
Time Factors
Tissue Plasminogen Activator / therapeutic use*
Vascular Patency / physiology
Ventricular Function, Left / physiology
Reg. No./Substance:
EC 3.4.-/Streptokinase; EC Plasminogen Activator
Comment In:
Circulation. 1994 Sep;90(3):1578   [PMID:  8087968 ]

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