[Long-term prognosis after reperfusion therapy with emergency coronary angioplasty for acute myocardial infarction].
The influence of emergency coronary angioplasty (PTCA) for acute myocardial infarction on long-term survival was investigated. We followed 141 patients treated with emergency PTCA and 202 patients treated with thrombolytic therapy alone for a median of 1,157 days and a median of 2,133 days, respectively. All were initially completely occluded at the infarct-related coronary artery (IRCA). Actuarial survival curves were compared and independent predictors of late cardiac death were determined using Cox's proportional hazard model between overall patients and patients whose IRCA was at the proximal site of the left anterior descending artery (LAD). 1. Actuarial survival curves were similar in 2 groups. 2. Independent predictors of late cardiac death in overall follow-up patients were advanced age over 65 years (p < 0.03), a history of previous myocardial infarction (p < 0.03), severer stage of the Killip class on admission (p < 0.003), and the infarct-related proximal LAD (p < 0.01). 3. Among patients with the proximal LAD, the actuarial survival curve was better in those treated with emergency PTCA than in those treated with thrombolytic therapy alone (p < 0.01). 4. Among patients with the proximal LAD, independent predictors of late cardiac death were advanced age over 65 years (p < 0.03), treatment with thrombolytic therapy alone (p < 0.03), left ventricular ejection fraction < or = 40% (p < 0.06), and occluded IRCA on predischarge angiograms (p < 0.08). Among patients with the occluded proximal LAD, those treated with emergency PTCA showed better long-term survival rate than did patients with thrombolytic therapy alone, and this may be explained by higher successful reperfusion rates in the former than in the latter.
Dote
K
K
Department of Cardiology, Hiroshima City Hospital.
Sato
H
H
Tateishi
H
H
Uchida
T
T
Ishihara
M
M
Yoshimura
M
M
Ohkura
Y
Y
Watanabe
M
M
Muraoka
Y
Y
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002423:Cause of Death; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion; D011379:Prognosis; D015996:Survival Rate; D015912:Thrombolytic Therapy