Adverse long-term effects of reocclusion after coronary thrombolysis.
OBJECTIVE
This study sought to assess the long-term clinical consequences of reocclusion after coronary thrombolysis.


BACKGROUND
After acute myocardial infarction successfully treated with thrombolysis, reocclusion occurs in approximately 30% of patients and leads to poorer in-hospital outcome. However, the long-term effects of reocclusion are unknown.


METHODS
Three hundred patients with no history of coronary surgery and with a patent infarct-related artery at coronary angiography within 48 h after thrombolysis were enrolled in the Antithrombotics in the Prevention of Reocclusion in Coronary Thrombolysis (APRICOT) trial. At a mean (+/- SD) of 77 +/- 23 days after thrombolysis, 248 patients (87%) underwent follow-up angiography. Reocclusion was observed in 71 (29%) of 248 patients. To compare outcome between 71 patients with and 177 without reocclusion an analysis of event-free survival, defined as a clinical course without death, reinfarction and revascularization, was performed.


RESULTS
Over a 3-year follow-up period, event-free survival was significantly better in patients without reocclusion: At 1 year it was 63% for patients with and 83% for those without reocclusion (p < 0.001). In the first year, two or more cardiac-related events occurred in 24% of patients with and 6% of those without reocclusion (p < 0.001). Patients with reocclusion had a markedly higher reinfarction and revascularization rate. At 1 year the reinfarction rate was 23% for patients with and 5% for those without reocclusion (p < 0.001).


CONCLUSIONS
This analysis shows the adverse influence of reocclusion on long-term clinical outcome in relation to reinfarction and need for revascularization. To further optimize prognosis after thrombolysis, prevention of reocclusion should become a main priority. Future research should focus on the criteria and timing of elective revascularization procedures in the prevention of coronary reocclusion.
Brouwer
M A
MA
Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands.
Böhncke
J R
JR
Veen
G
G
Meijer
A
A
van Eenige
M J
MJ
Verheugt
F W
FW
D000368:Aged; D017023:Coronary Angiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000517:prevention & control; D009204:Myocardial Revascularization; D012008:Recurrence; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D016896:Treatment Outcome