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[Long-term prognosis for patients undergoing thrombolysis during the acute phase of myocardial infarction]
A J Bosset1, P Vogt, E Eeckhout
1Division de Cardiologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Suisse.
Insights
Long-term outcomes after myocardial infarction thrombolysis show high morbidity. Ejection fraction and specific risk factors significantly impact patient survival and prognosis.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Myocardial infarction (MI) thrombolysis aims to restore blood flow.
- Long-term prognosis after acute MI treatment requires further investigation.
Purpose of the Study:
- To analyze long-term mortality and morbidity in patients treated with thrombolysis for acute myocardial infarction.
- To identify factors influencing prognosis after thrombolytic therapy.
Main Methods:
- 175 patients (149 men, 26 women, mean age 54) in a randomized study comparing two thrombolytic agents.
- Follow-up via physician questionnaires to assess long-term outcomes.
Main Results:
- Hospital mortality was 5%; 9% died within a mean follow-up of 4.3 years. 5-year survival was 81%.
- Lower ejection fraction (<40%) and absence of pre-infarction angina were associated with significantly lower survival.
- Risk factors for adverse events included age >65, multi-vessel coronary disease, and absence of pre-infarction angina.
Conclusions:
- Mortality and morbidity following myocardial infarction remain significant, with only 34% of patients event-free.
- Left ventricular ejection fraction is a critical prognostic indicator.
- Patient management should incorporate identified risk factors for improved outcomes.
Objective:
The objective of this study was to analyse the long-term mortality and morbidity of a group of patients undergoing thrombolysis during the acute phase of myocardial infarction and to determine the factors influencing the prognosis. One hundred and seventy five patients (149 mean and 26 women, mean age: 54 years) were included in a randomized study, comparing the efficacy of 2 thrombolytic substances administered during the acute phase of myocardial infarction. A standard questionnaire was sent to the various attending physicians to follow-up of these 175 patients.
Results:
The hospital mortality was 5% (9 patients) and 14 patients (9%) died after a mean follow-up of 4.3 +/- 2.1 years. The 5-year actuarial survival was 81%. Fourteen patients (8%) were lost to follow-up and 49 patients (32%) underwent surgical or percutaneous revascularization during follow-up. Revascularized patients had a significantly better survival than non-revascularized patients. The mean left ventricular ejection fraction of patients who died was lower (48% versus 71%) than that of survivors. Patients with an ejection fraction < 40% also had a significantly lower survival (p = 0.01). Patency of the vessel after thrombolysis was associated with a slightly better survival; this difference was not significant. The ejection fraction at 6 month was also significantly higher (60 +/- 10% versus 49 +/- 11%) for patients with a patent artery. Three risk factors for death or reinfarction were identified: age > 65 years at the time of infarction, disease in more than one coronary vessel and absence of angina pectoris before infarction. The probability of a coronary accident varied from 2 to 88% according to the number of risk factors present. At the time of follow-up, 60% of patients presented hypercholesterolaemia versus only 7% before infarction 73% of patients received anticoagulant or antiaggregant treatment and 81% of patients were asymptomatic.
Conclusion:
The mortality and the acute and long-term morbidity of myocardial infarction remain high, as only 34% of our patients did not develop any events during follow-up, despite serious medical management and follow-up. The ejection fraction has an important prognostic value. Patient management should take the abovementioned risk factors into account.