The role of intravenous coronary thrombolysis for patients with acute myocardial infarction in different treatment strategies.
OBJECTIVE
To examine acute-phase outcomes in acute myocardial infarction (AMI) according to different initial treatments.


METHODS
This retrospective study involved 405 patients with AMI who had undergone coronary angiography during the acute phase. The patients were retrospectively examined by dividing into groups according to treatment received: intravenous coronary thrombolysis (IVCT) (n=83), intracoronary thrombolysis (ICT) (n=62), and percutaneous coronary intervention (PCI) (n=221).


RESULTS
TIMI 3 flow at the initial angiography was higher in the IVCT group (P<0.05) at 32.5% in the IVCT group and 21.7% in the non-IVCT group. The time from onset to initiation of treatment was shorter in the IVCT group (P<0.001) at 227 min in the IVCT group, 337 min in the ICT group, and 479 min in the PCI group. The acute-phase mortality was lower in the IVCT group (P<0.05) at 2.4% in the IVCT group, 3.2% in the ICT group, and 11.8% in the PCI group. According to sub-analysis, the restenosis rate during the chronic phase after PCI did not differ with or without antecedent administration of a thrombolytic agent.


CONCLUSIONS
IVCT as an initial treatment for AMI enabled the fastest reperfusion at TIMI > or = 2 flow, resulting in a good acute-phase outcome.
Kobayashi
Hiroshi
H
Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tatemachi.
Takazawa
Kenji
K
Matsumoto
Chisa
C
Ooi
Kuniomi
K
Nagata
Takuya
T
Katou
Kouta
K
Yoshida
Masanobu
M
Aiga
Mamoru
M
Aizawa
Akira
A
Takahashi
Eiji
E
Namatame
Yasuhide
Y
Kinou
Mineko
M
Yamashina
Akira
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D015425:Myocardial Reperfusion; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome