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Long-term results of thrombolytic therapy with and without percutaneous transluminal coronary angioplasty
1Medical Clinic, Johannes Gutenberg University, Mainz, West Germany.
Insights
Adding immediate coronary angioplasty to streptokinase treatment for myocardial infarction did not significantly improve 3-year survival or clinical outcomes. Both treatment strategies showed similar long-term results in patients with acute transmural infarction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Acute transmural myocardial infarction requires prompt reperfusion therapy.
- Streptokinase is a thrombolytic agent used in myocardial infarction.
- Coronary angioplasty is an alternative reperfusion strategy.
Purpose of the Study:
- To evaluate the long-term effects of combined streptokinase and immediate coronary angioplasty versus streptokinase alone in acute transmural myocardial infarction.
- To compare clinical outcomes, reocclusion rates, heart failure incidence, and survival rates over a 3-year follow-up period.
Main Methods:
- A randomized study of 206 patients with acute transmural myocardial infarction.
- Group I received intravenous and intracoronary streptokinase without immediate angioplasty.
- Group II received streptokinase with immediate coronary angioplasty.
Main Results:
- No significant differences in 3-year survival rates (78% vs. 80%) between the groups.
- Similar rates of coronary reocclusion or reinfarction in reperfused vessels.
- Heart failure incidence was comparable in both groups (40%).
Conclusions:
- Immediate coronary angioplasty added to streptokinase therapy does not offer significant long-term clinical benefits or mortality reduction in acute transmural myocardial infarction.
- Both treatment strategies result in comparable long-term outcomes and survival rates.
Abstract:
The effects of combined intravenous and intracoronary streptokinase without (Group I, n = 103) or with (Group II, n = 103) immediate coronary angioplasty were evaluated during a long-term (3 year) follow-up of 206 patients with acute transmural myocardial infarction. There were no baseline differences between the groups with regard to gender, age, infarct location, serum creatine kinase levels, time between onset of symptoms and treatment and coronary artery patency rate. Angioplasty was performed with a success rate of 69% and a reocclusion rate of 2%. Elective angioplasty was performed in 22 (21%) of 103 patients in Group I and 9 (9%) of 103 patients in Group II, with a success rate of 86% and 100%, respectively, reflecting the higher incidence of angina pectoris and antianginal therapy in Group I. Coronary bypass surgery was performed in 21 (20%) of 103 patients in Group I and 20 (19%) of 103 patients in Group II; there was one operative death in each group. During follow-up, coronary reocclusion or reinfarction, or both, occurred in 25 (29%) of 87 patients in Group I and in 16 (18%) of 87 patients in Group II with reperfused vessels (p = NS). Heart failure occurred in 40% of the patients in both groups who had increased end-diastolic and end-systolic volumes. The survival rate after 3 years was 78% in Group I and 80% in Group II (p = NS). Thus, long-term follow-up of patients with acute transmural infarction treated with and without immediate angioplasty does not demonstrate any difference with regard to clinical outcome and mortality.