title: Coronary angioplasty performed within the thrombolysis in Myocardial Infarction II study.
abstract: BACKGROUND
  Percutaneous transluminal coronary angioplasty (PTCA) of the infarct-related artery was performed within 42 days of recombinant tissue-type plasminogen activator (rt-PA) administration in 1,414 of the 3,534 patients who participated in the Thrombolysis In Myocardial Infarction (TIMI) II study. Primary angiographic success was obtained in 88.7%, with bypass surgery within 24 hours in 3.3% and death within 24 hours in 0.7% of patients. By 1 year, 25.1% of the 1,414 patients had sustained one or more adverse outcomes including death (3.6%), reinfarction (8.4%), or the need for further revascularization (20%).
  
  
  RESULTS
  Despite these generally favorable results, multivariate testing identified several anatomic and clinical subgroups as having an increased risk ratio (RR) for adverse outcome: Unsuccessful PTCA was more common in patients undergoing protocol-assigned PTCA within 2 hours of rt-PA administration (RR, 2.7; p less than 0.001) and in patients over age 70 years (RR, 1.7; p = 0.034). The need for further revascularization within 1 year was increased in the 30.4% of patients with multivessel disease (RR, 2.5; p less than 0.001), patients with prior angina (RR, 1.4; p less than 0.006), or those undergoing ischemia-driven PTCA within 15 hours of rt-PA administration (RR, 1.7; p = 0.022). The risk of death or recurrent infarction within 1 year was increased by the presence of multivessel disease (RR, 1.6; p = 0.007) or prior angina (RR, 1.5; p = 0.014).
  
  
  CONCLUSIONS
  These observations do not necessarily apply to patients undergoing primary PTCA (or PTCA after other thrombolytic agents); however, they do offer a unique yardstick against which to evaluate the results of PTCA in myocardial infarction.
authors.affiliation: Cardiovascular Division, Beth Israel Hospital, Boston, MA 02215.
authors.forename: D S
authors.initials: DS
authors.lastname: Baim
authors.forename: D J
authors.initials: DJ
authors.lastname: Diver
authors.forename: F
authors.initials: F
authors.lastname: Feit
authors.forename: M A
authors.initials: MA
authors.lastname: Greenberg
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
authors.forename: B H
authors.initials: BH
authors.lastname: Weiner
authors.forename: D O
authors.initials: DO
authors.lastname: Williams
authors.forename: M J
authors.initials: MJ
authors.lastname: Schweiger
authors.forename: B G
authors.initials: BG
authors.lastname: Brown
authors.forename: M M
authors.initials: MM
authors.lastname: Frederick
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D003251:Constriction, Pathologic; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000473:pathology; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005544:Forecasting; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000628:therapy*; D012086:Reoperation; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents