Prediction of event-free survival after hospital discharge in acute myocardial infarction treated with tissue-plasminogen activator.
The incidence of recurrent ischemia, congestive heart failure and death during the first year after discharge were analysed prospectively in a group of 312 patients randomized double blindly to rt-PA (n = 156) or placebo within 5 hours after the onset of acute myocardial infarction. The in-hospital mortality was 4.4% in the rt-PA and 6.4% in the placebo group; the total-mortality after a follow-up of 16 months was respectively 7.6 and 9.6%. During 16 months follow-up reinfarction occurred in 5.4% of the rt-PA treated patients versus 0.0% in controls (p = 0.004). Revascularization was required in 17% of the population (24% in rt-PA versus 16% in controls, N.S.), angina at rest and congestive heart failure, demanding hospitalization developed in 5.1% of the patients (5.3% in rt-PA versus 4.7% in controls, N.S.) and 3.4% of the patients in each group died after discharge. A logistic model constructed to predict event-free survival showed that enzymatic infarct size, exercise capacity and the hemodynamic response at a predischarge bicycle exercise test and end-systolic volume at 2 weeks were predictors of new events. Considerable overlapping between patients with and without a new event was observed.
Brzostek
T
T
Institute of Cardiology, Krakow, Poland.
Van de Werf
F
F
Scheys
I
I
Lesaffre
E
E
Dubiel
J
J
De Geest
H
H
D004311:Double-Blind Method; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology; D009204:Myocardial Revascularization; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D015996:Survival Rate; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D010959:Tissue Plasminogen Activator