Long-term effects of invasive treatment in patients with a post-thrombolytic Q-wave myocardial infarction.
OBJECTIVE
The aim of the present study was to assess the effect of a deferred invasive treatment strategy on long-term outcome in patients with a post-thrombolytic Q-wave myocardial infarction and inducible myocardial ischemia.


METHODS
Patients (N=751) with post-thrombolytic Q-wave myocardial infarction and inducible ischemia (angina pectoris or silent myocardial ischemia) were randomized to a deferred invasive treatment (balloon angioplasty or coronary bypass surgery) or medical treatment. Vital status and non-fatal cardiac events defined as hospitalization caused by acute cardiac events were recorded for a median of 11.4 years.


RESULTS
Survival was significantly improved in patients receiving invasive treatment compared to patients treated medically (hazard ratio 0.85 (95% confidence limits 0.73-0.99), p=0.034). Subgroup analysis showed a reduction of non-fatal cardiac events and improved survival among the patients with post-infarction angina pectoris and not among the patients with silent myocardial ischemia.


CONCLUSIONS
A deferred invasive treatment strategy improves survival compared to medical treatment in patients with inducible myocardial ischemia after a post-thrombolytic Q-wave myocardial infarction.
Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark. kkofoed@dadlnet.dk
Klaus F
KF
Kofoed
Jan K
JK
Madsen
Peer
P
Grande
Kari
K
Saunamäki
Torsten Toftegård
TT
Nielsen
Eli
E
Kassis
Per
P
Thayssen
Klaus
K
Rasmussen
D000787:Angina Pectoris / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D017202:Myocardial Ischemia / Q000150:complications / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome