title: Variables predictive of good functional outcome following thrombolytic therapy in the Thrombolysis in Myocardial Infarction phase II (TIMI II) pilot study.
abstract: Before commencing the randomized Thrombolysis in Myocardial Infarction phase II (TIMI II) study, 370 patients were administered intravenous recombinant tissue plasminogen activator (rt-PA) within 4 hours of onset of acute myocardial infarction (AMI) and assigned to 2-hour (immediate) percutaneous transluminal angioplasty (n = 33), 18- to 48-hour (delayed) angioplasty (n = 288) or no angioplasty (n = 49) in a nonrandomized, observational pilot study. Left ventricular ejection fraction at rest and during exercise was assessed by gated equilibrium radionuclide ventriculography at hospital discharge and again at 6 weeks. At hospital discharge, ejection fraction averaged 50% at rest and 56% at peak exercise. At 6-week follow-up, ejection fraction averaged 50% at rest and 53% at peak exercise. At 6-week follow-up, resting ejection fraction average 49% in the 2-hour angioplasty group, 49% in the 18- to 48-hour angioplasty group and 55% in the no-angioplasty group. Variables independently predicting "good functional outcome" at 6-week follow-up (survival with resting ejection fraction greater than equal to 50% and no decrease with exercise) in the 18- to 48-hour angioplasty group were fewer leads with ST-segment elevation greater than or equal to 0.1 mV, younger age, rapid normalization during rt-PA infusion of ST segments or dramatic relief of chest pain, absence of arrhythmias within the first 24 hours of treatment initiation, no prior infarction and not a cigarette smoker at entry. Thus, the TIMI II pilot study demonstrates that most patients with AMI of less than or equal to 4-hour duration treated with rt-PA have good ventricular function after AMI.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: TIMI Coordinating Center, Baltimore, Maryland.
authors.forename: W J
authors.initials: WJ
authors.lastname: Rogers
authors.forename: R C
authors.initials: RC
authors.lastname: Bourge
authors.forename: S E
authors.initials: SE
authors.lastname: Papapietro
authors.forename: F J
authors.initials: FJ
authors.lastname: Wackers
authors.forename: B L
authors.initials: BL
authors.lastname: Zaret
authors.forename: S
authors.initials: S
authors.lastname: Forman
authors.forename: H T
authors.initials: HT
authors.lastname: Dodge
authors.forename: T L
authors.initials: TL
authors.lastname: Robertson
authors.forename: E R
authors.initials: ER
authors.lastname: Passamani
authors.forename: E
authors.initials: E
authors.lastname: Braunwald
mesh_terms: D000792:Angiography; D000800:Angioplasty, Balloon; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D010865:Pilot Projects; D011897:Random Allocation; D011994:Recombinant Proteins / Q000627:therapeutic use; D013318:Stroke Volume; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator