title: Prognostic importance of left ventricular function after angioplasty or thrombolysis for acute myocardial infarction.
abstract: OBJECTIVE
  To compare long-term clinical outcome after acute myocardial infarction treated with primary coronary angioplasty or thrombolytic therapy, and to study the determinants of survival.
  
  
  BACKGROUND
  Primary coronary angioplasty results in a higher patency rate and a better short-term survival when compared with thrombolytic therapy, but so far limited information has been available regarding long-term clinical outcome.
  
  
  METHODS
  Patients with acute myocardial infarction (n=395) were randomised to treatment with either intravenous streptokinase or primary angioplasty, and were followed for up to eight years.
  
  
  RESULTS
  A total of 105 patients died, 42 patients in the primary coronary angioplasty group compared with 63 patients in the streptokinase group (p=0.03). Death and nonfatal reinfarction occurred in 53 patients in the angioplasty group, compared with 94 patients in the streptokinase group (p<0.001). The major cause of long-term mortality is sudden death. Multivariate analysis showed that left ventricular function was the most important predictor for both total mortality and sudden death.
  
  
  CONCLUSIONS
  The benefits of primary coronary angioplasty compared with streptokinase are well sustained during long-term follow-up.
authors.forename: J P S
authors.initials: JP
authors.lastname: Henriques
authors.forename: M J
authors.initials: MJ
authors.lastname: de Boer
authors.forename: A W J
authors.initials: AW
authors.lastname: van 't Hof
authors.forename: J C A
authors.initials: JC
authors.lastname: Hoorntje
authors.forename: K
authors.initials: K
authors.lastname: Miedema
authors.forename: J P
authors.initials: JP
authors.lastname: Ottervanger
authors.forename: S
authors.initials: S
authors.lastname: Reiffers
authors.forename: H
authors.initials: H
authors.lastname: Suryapranata
authors.forename: F
authors.initials: F
authors.lastname: Zijlstra
keywords: myocardial infarction; primary coronary angioplasty; streptokinase; sudden death; ventricular function