title: Six-year survival after coronary thrombolysis and early revascularization for acute myocardial infarction.
abstract: Six-year follow-up was conducted in a consecutive series of 192 patients receiving thrombolytic therapy for acute myocardial infarction (AMI) with ST-segment elevation. Cardiac catheterization was performed within a day, and patients with an open infarct artery routinely had early revascularization: 99 (67%) underwent coronary bypass surgery and 18 (12%) coronary angioplasty. With this treatment strategy, 6-year cardiac mortality was 14.5%, 6% (12 patients) in hospital and 9% (16 patients) for survivors of hospitalization. Multivariate analysis showed that predictors of cardiac death among survivors of hospitalization were a closed infarct artery at catheterization (p less than 0.01), diabetes (p less than 0.01) and anterior myocardial infarction (p = 0.01). A subset of 146 patients underwent radionuclide angiography before hospital discharge; for them, predictors of mortality were a closed infarct artery at catheterization (p less than 0.01), anterior wall AMI (p = 0.02), and Killip class III to IV on admission (p less than 0.06). Left ventricular ejection fraction was not a significant predictor of mortality for this subset of patients.
authors.affiliation: Prairie Cardiovascular Center, Springfield, Illinois.
authors.forename: G J
authors.initials: GJ
authors.lastname: Taylor
authors.forename: H W
authors.initials: HW
authors.lastname: Moses
authors.forename: R E
authors.initials: RE
authors.lastname: Katholi
authors.forename: C
authors.initials: C
authors.lastname: Korsmeyer
authors.forename: P
authors.initials: P
authors.lastname: Kolm
authors.forename: J T
authors.initials: JT
authors.lastname: Dove
authors.forename: F L
authors.initials: FL
authors.lastname: Mikell
authors.forename: J M
authors.initials: JM
authors.lastname: Sutton
authors.forename: H A
authors.initials: HA
authors.lastname: Wellons
authors.forename: J A
authors.initials: JA
authors.lastname: Schneider
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy*; D012044:Regression Analysis; D016019:Survival Analysis; D015912:Thrombolytic Therapy