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Published on: November 27, 2013
One-year follow-up after recombinant tissue plasminogen activator administered to patients with acute myocardial
A J McNeill1, W Dickey, N P Campbell
1Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, N. Ireland.
Insights
This study found low mortality and reinfarction rates in acute myocardial infarction patients treated with angioplasty, bypass grafting, and medications. Early intervention and aggressive treatment strategies contribute to favorable outcomes in heart attack survivors.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Acute myocardial infarction (AMI) remains a leading cause of mortality.
- Effective management strategies are crucial for improving patient outcomes.
- Early reperfusion therapies and subsequent interventions significantly impact prognosis.
Purpose of the Study:
- To evaluate the one-year outcomes of patients experiencing acute myocardial infarction.
- To assess the impact of various treatment modalities, including angioplasty and coronary artery bypass grafting, on patient survival and reinfarction rates.
- To analyze the incidence of cardiac symptoms and medication use in AMI survivors.
Main Methods:
- Retrospective review of 106 patients admitted with acute myocardial infarction within 4 hours of symptom onset.
- Analysis of treatment strategies: medical therapy alone, angioplasty, and coronary artery bypass grafting.
- One-year follow-up to assess mortality, reinfarction, hospital admissions, and symptom status (angina, dyspnea).
- Documentation of medication use, including nitrates, calcium antagonists, beta-blockers, and anti-platelet agents.
Main Results:
- The in-hospital mortality rate was 9 out of 106 patients (8.5%), with 4 deaths (4.1%) occurring within one year post-discharge.
- Reinfarction occurred in 2 out of 93 survivors (2.2%) within the follow-up year.
- 18 patients underwent angioplasty (12 successful), and 15 had coronary artery bypass grafting.
- At follow-up, 22 patients reported angina and 5 reported dyspnea; many were on prophylactic anti-anginal therapy.
Conclusions:
- Recombinant tissue plasminogen activator therapy followed by hospital discharge resulted in a low one-year mortality (4.1%) and reinfarction rate (2.2%) in this cohort of acute myocardial infarction patients.
- The high utilization of angioplasty, coronary artery bypass grafting, and anti-anginal agents likely contributed to the low incidence of cardiac symptoms in survivors.
- Aggressive early treatment and comprehensive post-infarction management appear effective in reducing adverse cardiovascular events.
Abstract:
Of 106 patients seen within 4 h of chest pain with 107 episodes of acute myocardial infarction, nine died before or during hospitalization mainly from cardiogenic shock, and four died during the next year, three were sudden deaths. The 93 survivors were reviewed at a mean of 53 (range 49-70) weeks after infarction. Of these 93, 18 had had attempted angioplasty (successful in 12) and 15 had had coronary artery bypass grafting (including one patient who had coronary artery bypass grafting performed after unsuccessful angioplasty). The remaining 61 patients continued on medical therapy only. During the one-year follow-up two patients suffered reinfarction and a further 22 had one or more cardiac admissions, mostly for chest pain. At review, 22 patients had angina (16 New York Heart Association Grade I or II) and five dyspnoea (all NYHA Grade II). Forty-three patients were taking oral nitrates, 53 were receiving calcium antagonists, 54 were using betablocking agents and 73 used anti-platelet agents. However, many of these patients continued on anti-anginal therapy prophylactically after their myocardial infarction, without continuing chest pain. Thus after recombinant tissue plasminogen activator therapy and following hospital discharge the mortality rate for patients with acute myocardial infarction was four out of 97 (4.1%) and reinfarction rate among survivors was two out of 93 (2.2%). Although the incidence of cardiac symptoms was low this may be partly due to the high incidence of angioplasty and coronary artery grafting, together with the use of anti-anginal agents.
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