Early and long-term clinical outcomes associated with reinfarction following fibrinolytic administration in the Thrombolysis in Myocardial Infarction trials.
OBJECTIVE
We hypothesized that early recurrent myocardial infarction (MI) following fibrinolytic administration would be assessed with higher mortality at both 30 days and 2 years.


BACKGROUND
Although early recurrent MI after fibrinolytic therapy has been associated with increased early mortality in the acute MI setting, its relation to long-term mortality has not been fully explored.


METHODS
Mortality data were ascertained in 20,101 patients enrolled in the Thrombolysis In Myocardial Infarction (TIMI) 4, 9, and 10B and Intravenous NPA for the Treatment of Infarcting Myocardium Early (InTIME-II) acute MI trials.


RESULTS
The frequency of symptomatic recurrent MI during the index hospitalization was 4.2% (836/20,101). Recurrent MI during the index hospital period was associated with increased 30-day mortality (16.4% [137/836] vs. 6.2% [1,188/19,260], p < 0.001). Likewise, recurrent MI was associated with a sustained increase in mortality up to two years, even after adjustments were made for covariates known to be associated with mortality and recurrent MI (hazard ratio 2.11, p < 0.001). However, this higher mortality at 2 years was due to an early divergence in mortality by 30 days and was not due to a significant increase in late mortality between 30 days and 2 years (4.38% [31/707] vs. 3.76% [685/18,206], p = NS). Percutaneous coronary intervention during the index hospitalization was associated with a lower rate of in-hospital recurrent MI (1.6% vs. 4.5%, p < 0.001) and lower two-year mortality (5.6% vs. 11.6%, p < 0.001). Performance of coronary artery bypass graft surgery was also associated with a lower recurrent rate of MI (0.7% vs. 4.3%, p < 0.001) and lower two-year mortality rate (7.95% vs. 10.6%, p = 0.0008).


CONCLUSIONS
Early recurrent MI is associated with increased mortality up to two years. However, most deaths occur early, and the risk of additional deaths between the index hospital period and two years was not significantly increased among patients with recurrent MI. Percutaneous coronary intervention during the index hospitalization was associated with a lower risk of recurrent MI and a lower risk of two-year mortality.
Gibson
C Michael
CM
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 350 Longwood Avenue, 1st Floor, Boston, MA 02115, USA. mgibson@perfuse.org
Karha
Juhana
J
Murphy
Sabina A
SA
James
David
D
Morrow
David A
DA
Cannon
Christopher P
CP
Giugliano
Robert P
RP
Antman
Elliott M
EM
Braunwald
Eugene
E
D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D001026:Coronary Artery Bypass; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D005343:Fibrinolytic Agents