Three life years gained after reperfusion therapy in acute myocardial infarction: 25-30 years after a randomized
Ron T van Domburg1, Jeroen M Hendriks, Otto Kamp
1Department of Cardiology, Erasmus Medical Center, 's-Gravendijkwal 230,Rotterdam, The Netherlands. r.vandomburg@erasmusmc.nl
Insights
Reperfusion therapy for acute myocardial infarction significantly improves long-term survival and life expectancy. This treatment offers sustained benefits, adding over three years to patients' lives.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Acute myocardial infarction (AMI) treatment aims to limit infarct size and improve survival.
- Reperfusion therapy is a key intervention for AMI.
- Long-term benefits of reperfusion therapy require sustained investigation.
Purpose of the Study:
- To evaluate the long-term survival benefit of reperfusion therapy for AMI.
- To assess the gain in life expectancy associated with reperfusion therapy.
- To identify predictors of long-term mortality after AMI.
Main Methods:
- A randomized controlled trial comparing reperfusion therapy with conventional therapy in 533 AMI patients (1980-1985).
- Median follow-up of 27 years.
- Multivariable analysis to determine independent predictors of mortality.
Main Results:
- Reperfusion therapy group had higher long-term survival rates (22% vs. 15% alive at follow-up; p=0.02).
- Cumulative survival rates at 25 years were significantly better with reperfusion (24% vs. 18%; p<0.001).
- Life expectancy was 15.6 years with reperfusion versus 12.5 years with conventional therapy (p<0.02).
Conclusions:
- The benefits of early reperfusion therapy for AMI are sustained throughout a patient's lifetime.
- Reperfusion therapy resulted in a gain of over 3 life years.
- Reperfusion therapy is an independent predictor of lower long-term mortality.
Aim:
Reperfusion therapy in acute myocardial infarction reduces infarct size and increases hospital survival. We investigated whether the benefit of reperfusion therapy for myocardial infarction was sustained long-term and assessed the gain in life expectancy by reperfusion therapy.
Methods And Results:
We analysed the outcome of 533 patients (mean age 56 years, 82% men), who were randomized to either reperfusion therapy or conventional therapy during 1980-1985. Median follow up was 27 years (25-30 years). At follow up, 59 patients (22%) of the 269 patients allocated to reperfusion treatment and only 39 patients (15%) of the 264 conventionally treated patients were still alive (p = 0.02). The cumulative 10-, 15-, 20-, and 25-year survival rates were 69, 48, 37, and 24% after reperfusion therapy and 59, 38, 27, and 18% in the control group, respectively (p < 0.001). Life expectancy of the reperfusion group was 15.6 years vs. 12.5 years in the conventionally treated group (p < 0.02). Myocardial reinfarction and subsequent coronary interventions were more frequent after reperfusion therapy, particularly during the first year. In multivariable analysis, reperfusion therapy was an important independent predictor of lower mortality at long-term follow up. Other independent predictors of mortality were age, impaired left ventricular function, multivessel disease, infarct size, and inability to perform an exercise test at the time of discharge.
Conclusion:
These data confirm that the benefits of early reperfusion therapy for acute myocardial infarction are sustained throughout the lifetime of the patients. More than 3 life years were gained by reperfusion therapy.
