title: Clinical predictors of early infarct-related artery patency following thrombolytic therapy: importance of body weight, smoking history, infarct-related artery and choice of thrombolytic regimen: the GUSTO-I experience. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries.
abstract: OBJECTIVE
  The purpose of this study was to determine patient characteristics that are a priori predictors of early infarct related artery patency following thrombolytic therapy, and to provide a paradigm which may identify patients who would be most likely to achieve restoration of normal (TIMI 3) coronary flow in response to thrombolytic therapy.
  
  
  BACKGROUND
  Restoration of infarct-related artery perfusion in acute myocardial infarction is necessary for preservation of ventricular function and mortality reduction. Clinical variables that are a priori predictors of early patency with currently available thrombolytic regimens have not been fully characterized.
  
  
  METHODS
  The probability of early infarct-related artery patency (TIMI 3 flow) was determined by multivariable logistic regression. We determined a reduced (parsimonious) model for predicting early (90 min) infarct-related artery patency (TIMI grade 3) based on data from 1,030 patients in the GUSTO-I Angiographic study.
  
  
  RESULTS
  Predictors of 90 min TIMI 3 flow are use of an accelerated t-PA regimen (vs. streptokinase containing regimens) (chi2=39.1; p < or = 0.0001), infarct related artery (RCA/Lcx vs. LAD) (chi2=12.7; p=0.0004), body weight (chi2=10.3; p=0.001) and history of smoking (chi2=7.4; p=0.007). Time from symptom onset to treatment was not significant (p=0.71).
  
  
  CONCLUSIONS
  The efficacy of currently available thrombolytic regimens is chiefly dependent on choice of thrombolytic regimen, body weight, infarct-related coronary artery and smoking history. Clinical variables alone correctly predict a priori TIMI 3 flow in the infarct-related artery 64% of the time. Patients with body weights greater than 85 kg are at a significant disadvantage with regard to achieving successful thrombolysis compared to those with lesser body weights.
authors.affiliation: Cardiovascular Research Institute and the GUSTO-I Core Angiographic Laboratory, The George Washington University, Washington, DC, USA.
authors.forename: C F
authors.initials: CF
authors.lastname: Lundergan
authors.forename: J S
authors.initials: JS
authors.lastname: Reiner
authors.forename: W F
authors.initials: WF
authors.lastname: McCarthy
authors.forename: K S
authors.initials: KS
authors.lastname: Coyne
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: A M
authors.initials: AM
authors.lastname: Ross
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000187:drug effects; D003326:Coronary Circulation / Q000187:drug effects*; D004359:Drug Therapy, Combination; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D013300:Streptokinase / Q000008:administration & dosage* / Q000009:adverse effects; D015996:Survival Rate; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects*; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D006493:Heparin; D013300:Streptokinase; D010959:Tissue Plasminogen Activator