title: Thrombolytic therapy for acute myocardial infarction: evaluation of a selective approach to invasive diagnosis and therapy in a community hospital.
abstract: To investigate the effectiveness of selective catheterization and revascularization after thrombolytic therapy for myocardial infarction, we studied the early and late clinical course of 100 consecutive patients treated with streptokinase and an intensive medical regimen. Catheterization was performed because of recurrent angina or evidence for reperfusion and myocardial salvage. Fifty-six patients were catheterized, and 37 underwent revascularization. Hospital mortality was 8%. Among the 92 hospital survivors, after 1 year follow-up there was no significant difference between the revascularized and nonrevascularized groups in total survival (97% and 100%, respectively) or in infarct-free survival (97% and 95%, respectively). During total follow-up of 34 (+/- 13) months, late clinical events (death, reinfarction, late revascularization, and severe angina) occurred in 16% of 37 revascularized patients and in 27% of 55 patients not revascularized (p = 0.31). Cumulative hospital and late survival for the entire group was 91% at 1 year and 86% at final evaluation. Excellent long-term survival and a low incidence of recurrent infarction may be achieved after thrombolytic therapy, using selective catheterization and revascularization based on widely available clinical estimates of further ischemic risk.
authors.affiliation: Williamsport Hospital & Medical Center, Pennsylvania 17701.
authors.forename: J M
authors.initials: JM
authors.lastname: Burks
authors.forename: J C
authors.initials: JC
authors.lastname: Kirby
authors.forename: E C
authors.initials: EC
authors.lastname: Keating
authors.forename: J R
authors.initials: JR
authors.lastname: Calder
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization / Q000592:standards*; D012008:Recurrence; D013300:Streptokinase / Q000627:therapeutic use; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000592:standards*
chemical_list: D013300:Streptokinase