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Long-term prognosis after thrombolytic therapy for acute myocardial infarction
K Kosuga1, R Hattori, H Eizawa
1Department of Internal Medicine, Faculty of Medicine, Kyoto University, Japan.
Insights
Maintaining blood flow in infarcted arteries after thrombolytic therapy improved short-term survival for acute myocardial infarction patients. However, long-term cardiac death rates were similar between patients with patent and occluded arteries.
Area of Science:
- Cardiology
- Vascular Medicine
- Thrombolytic Therapy
Background:
- Acute myocardial infarction (AMI) management often involves thrombolytic therapy to restore blood flow.
- The long-term prognostic significance of infarct-related artery patency after thrombolysis remains an area of investigation.
Purpose of the Study:
- To investigate the relationship between infarct-related artery patency and long-term prognosis in patients with AMI treated with thrombolysis.
Main Methods:
- A cohort of 116 patients with AMI treated with urokinase (intracoronary or intravenous) was evaluated.
- Patients were categorized into patent (recanalized) and occluded groups based on vessel status post-thrombolysis.
- Long-term follow-up (5 and 8 years) was conducted to assess survival rates.
Main Results:
- Recanalization was achieved in 52 patients (patent group), while 64 remained occluded.
- Survival rates at 1, 5, and 8 years were 91.8%, 80.8%, and 75.9% for the patent group, versus 80.9%, 79.2%, and 75.6% for the occluded group.
- While the patent group showed a trend towards higher survival up to 4 years, survival rates became similar after 5 years.
Conclusions:
- Reopening of the infarct-related artery following thrombolytic therapy was not an independent predictor of late cardiac death.
- The long-term prognostic impact of achieved patency after thrombolysis in AMI appears limited beyond the initial post-event period.
Abstract:
In order to clarify the relationship between the patency of the infarcted arteries and subsequent long-term prognosis after thrombolytic therapy, we evaluated 116 patients with acute myocardial infarction treated with intracoronary (112 patients) or intravenous (four patients) urokinase. Patients treated with angioplasty after thrombolysis were excluded. The infarcted vessel was recanalized in 52 patients (patent group) and was not in the remaining 64 patients (occluded group). Five-year and 8-year follow up was conducted in 91% and 81% of the patients, respectively. The 1-, 5- and 8-year survival rate for the patent and occluded group was 91.8 and 80.9%, 80.8 and 79.2%, and 75.9 and 75.6%, respectively. The survival rate in the patent group tended to be higher than that in the occluded group up to 4 years. However, after 5 years, both groups showed similar survival rates. Therefore, reopening of the infarcted arteries with thrombolysis was not an independent predictor for late cardiac death (Cox regression analysis).