[The long-term efficacy of fibrinolytic treatment in the acute phase of a myocardial infarct. A comparison with a control group].
BACKGROUND
The follow-up of patients with an acute myocardial infarction treated with fibrinolysis and that of patients treated with conventional therapy was analyzed.


METHODS
The study cohort included: 1) 214 patients with a first acute infarction of < or = 4 hours and with < or = 70 years of age who participated in a randomized study comparing the effects of streptokinase (SK, n: 110) vs conventional treatment (control, n: 104), and 2) a total of 361 patients with a myocardial infarction of < or = 6 hours and < or = 75 years old treated with fibrinolytic agents.


RESULTS
In-hospital mortality in the randomized study was 11% for the control group and 7% for the SK group, and 8.8% for the rest of patients treated with fibrinolysis. Mortality during follow-up in the randomized study (7.0 +/- 1.5 years) was 10.7% for the SK group and 19.3% for the control group. Ejection fraction was significantly lower in non survivors than in survivors (36.7% vs 50.8%, (p < 0.0001) and among patients with an ejection fraction < 50%, follow-up mortality was significantly lower in those with a complete recanalization (TIMI 3) than in those with an absent or incomplete recanalization (TIMI 0-2) (98% vs 22%). Follow-up mortality for the rest of patients treated with fibrinolysis (2.6 +/- 1.6 years) was 9%.


CONCLUSIONS
1) The reduction of in-hospital mortality by fibrinolysis appears to increase in the long-term follow-up, and 2) the long-term survival seems to be related not only to the left ventricular function but also to the extent of angiographic recanalization.
Cortadellas Angel
J
J
Servicio de Cardiología, Hospital General Universitari Vall d'Hebron, Barcelona.
Figueras Bellot
J
J
Lainez Royo
R
R
Nieto Santa
E
E
Díaz Poveda
A
A
Bermejo Fraile
B
B
Soler Soler
J
J
D016009:Chi-Square Distribution; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D013030:Spain / Q000453:epidemiology; D013300:Streptokinase / Q000627:therapeutic use*; D017741:Survivors / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy / Q000379:methods / Q000706:statistics & numerical data
D013300:Streptokinase