[Influence of systemic arterial hypertension on mid-term survival of patients with acute myocardial infarction treated with fibrinolytic agents].
BACKGROUND
The purpose of this study to asses the effect of systemic arterial hypertension on mid-term survival of patients with acute myocardial infarction who received thrombolytic treatment.


METHODS
We studied 202 consecutive patients with acute myocardial infarction, admitted in the Coronary Care Unit of the Hospital Xeral de Galicia who received intravenous thrombolytic therapy within six hours from the onset of symptoms. The thrombolytics used were: urokinase (79.7%), rt-PA (9.9%), streptokinase (4.9%) and APSAC (5.5%). Left heart catheterization with coronary angiography was performed in 162 patients at 2 weeks after infarction. Patency of the infarction-related artery (IRA) was classified according to Thrombolysis in Myocardial Infarction (TIMI) criteria. A patent artery weas defined as having TIMI grades 2 or 3 antegrade flow.


RESULTS
Systemic arterial hypertension was found in 34.7% of patients. IRA patency (TIMI 2-3) was demonstrated in the 75.3% of the patients. Early mortality (first month) was 5.4%. Multivariate analysis identified cardiogenic shock as the only variable with independent predictive value for early mortality. Mean follow-up was for 24 +/- 19 months. Late mortality was 5.2% and cardiac death occurred in 4.2% of patients. Reinfarction occurred in 3.1% of patients. Congestive heart failure, arterial hypertension and reinfarction adversely affected prognosis. Actuarial survival at the end of follow-up period was significantly lower in patients with systemic arterial hypertension (70.4% vs 85.9%; p < 0.05).


CONCLUSIONS
These data suggest that systemic arterial hypertension adversely affects mid-term prognosis in patients with acute myocardial infarction who received thrombolytic treatment.
Martínez Sande
J L
JL
Servicio de Cardiología y Unidad Coronaria, Hospital Xeral De Galicia-Clínico Universitario, Santiago de Compostela, La Coruña.
González-Juanatey
J R
JR
García-Acuña
J M
JM
Amaro Cendón
A
A
Fernández Vázquez
F
F
Fernández López
J A
JA
García Seara
J
J
Vega Fernández
J M
JM
López Lago
A
A
Gil de la Peña
M
M
D000208:Acute Disease; D000368:Aged; D002404:Catheterization; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000175:diagnosis; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
D005343:Fibrinolytic Agents
Influencia de la hipertensión arterial sistémica en la supervivencia a medio plazo de los pacientes con infarto agudo de miocardio que han recibido tratamiento fibrinolítico.