Coronary angioplasty performed within the thrombolysis in Myocardial Infarction II study.
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.
Baim
D S
DS
Cardiovascular Division, Beth Israel Hospital, Boston, MA 02215.
Diver
D J
DJ
Feit
F
F
Greenberg
M A
MA
Holmes
D R
DR
Weiner
B H
BH
Williams
D O
DO
Schweiger
M J
MJ
Brown
B G
BG
Frederick
M M
MM
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
D005343:Fibrinolytic Agents