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Six-year survival after coronary thrombolysis and early revascularization for acute myocardial infarction
G J Taylor1, H W Moses, R E Katholi
1Prairie Cardiovascular Center, Springfield, Illinois.
Insights
Early revascularization after thrombolytic therapy for ST-elevation myocardial infarction (STEMI) resulted in a 14.5% six-year cardiac mortality. Key predictors of death in survivors included a closed infarct artery and diabetes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Thrombolytic therapy is a cornerstone treatment for ST-elevation myocardial infarction (STEMI).
- Early revascularization strategies aim to improve outcomes in STEMI patients.
- Long-term data on the impact of early revascularization following thrombolysis are crucial.
Purpose of the Study:
- To evaluate the six-year cardiac mortality in patients with STEMI treated with thrombolysis and early revascularization.
- To identify predictors of cardiac death among STEMI survivors.
Main Methods:
- A consecutive series of 192 STEMI patients receiving thrombolytic therapy were followed for six years.
- Cardiac catheterization was performed within 24 hours, with routine early revascularization (coronary bypass surgery or angioplasty) for open infarct arteries.
- Multivariate analysis and radionuclide angiography were used to assess mortality predictors.
Main Results:
- Overall six-year cardiac mortality was 14.5% (6% in-hospital, 9% post-hospitalization).
- Predictors of cardiac death in survivors included a closed infarct artery (p<0.01), diabetes (p<0.01), and anterior STEMI (p=0.01).
- In a subset, a closed infarct artery (p<0.01), anterior STEMI (p=0.02), and Killip class III-IV (p<0.06) predicted mortality; ejection fraction was not significant.
Conclusions:
- A strategy of thrombolysis followed by early revascularization yields a 14.5% six-year cardiac mortality for STEMI.
- Maintaining an open infarct artery is critical for long-term survival.
- Diabetes and anterior STEMI are significant risk factors for mortality in STEMI survivors.
Abstract:
Six-year follow-up was conducted in a consecutive series of 192 patients receiving thrombolytic therapy for acute myocardial infarction (AMI) with ST-segment elevation. Cardiac catheterization was performed within a day, and patients with an open infarct artery routinely had early revascularization: 99 (67%) underwent coronary bypass surgery and 18 (12%) coronary angioplasty. With this treatment strategy, 6-year cardiac mortality was 14.5%, 6% (12 patients) in hospital and 9% (16 patients) for survivors of hospitalization. Multivariate analysis showed that predictors of cardiac death among survivors of hospitalization were a closed infarct artery at catheterization (p less than 0.01), diabetes (p less than 0.01) and anterior myocardial infarction (p = 0.01). A subset of 146 patients underwent radionuclide angiography before hospital discharge; for them, predictors of mortality were a closed infarct artery at catheterization (p less than 0.01), anterior wall AMI (p = 0.02), and Killip class III to IV on admission (p less than 0.06). Left ventricular ejection fraction was not a significant predictor of mortality for this subset of patients.