| Long-term prognostic importance of patency of the infarct-related coronary artery after thrombolytic therapy for acute myocardial infarction. | |
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MedLine Citation:
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PMID: 8281696 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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H D White; D B Cross; J M Elliott; R M Norris; T W Yee |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Circulation Volume: 89 ISSN: 0009-7322 ISO Abbreviation: Circulation Publication Date: 1994 Jan |
Date Detail:
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Created Date: 1994-02-17 Completed Date: 1994-02-17 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 61-7 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Research, Green Lane Hospital, Auckland, New Zealand. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Coronary Vessels
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physiopathology* Female Follow-Up Studies Heart Catheterization Humans Male Middle Aged Multivariate Analysis Myocardial Infarction / drug therapy*, epidemiology, physiopathology Prognosis Streptokinase / therapeutic use* Thrombolytic Therapy* Time Factors Tissue Plasminogen Activator / therapeutic use* Vascular Patency / physiology Ventricular Function, Left / physiology |
| Chemical | |
Reg. No./Substance:
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EC 3.4.-/Streptokinase; EC 3.4.21.68/Tissue Plasminogen Activator |
| Comments/Corrections | |
Comment In:
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Circulation. 1994 Sep;90(3):1578
[PMID:
8087968
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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