Adverse long-term effects of reocclusion after coronary thrombolysis

Brouwer, Marc A.; Böhncke, Jan R.; Veen, Gerrit; Meijer, A.; Eenige, M. J. van; Verheugt, Freek W.A.

doi:10.1016/0735-1097(95)00355-x

Cited by 40 publications

(17 citation statements)

References 27 publications

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“…The reduced risk was observed consistently across many different subgroups and occurred independent of antithrombotic regimen and culprit stenosis severity, a known strong predictor of reocclusion in this setting [27][28][29]. The majority of reocclusions have been shown to occur without clinical reinfarction [12][13][14]. In our study reocclusion occurred without clinical reinfarction in almost 80% of cases, while 46% of patients with reocclusion did not experience recurrent ischemic events.…”

Section: Smoking and Reocclusionsupporting

confidence: 60%

“…Given the strong relationship between reocclusion and outcome after successful fibrinolysis [12][13][14], previous studies addressed the risk of reocclusion in smokers in search for potential mechanisms explaining their favorable outcome. Results of these studies have been conflicting.…”

Section: Smoking and Reocclusionmentioning

confidence: 99%

“…After successful fibrinolysis, outcome is strongly related to reocclusion of the infarct artery, which portends an increased risk of death, reinfarction and revascularization [12][13][14]. Notably, most reocclusions occur without clinical reinfarction [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Notably, most reocclusions occur without clinical reinfarction [12][13][14]. Even in these cases, reocclusion has adverse impact on recovery of left ventricular function [15].…”

Section: Introductionmentioning

confidence: 99%

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The smoker’s paradox after successful fibrinolysis: reduced risk of reocclusion but no improved long-term cardiac outcome

Kievit

Brouwer

Veen

et al. 2008

J Thromb Thrombolysis

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Background In smokers treated with fibrinolysis for ST-elevation myocardial infarction (STEMI) a paradoxical beneficial short-term outcome has been reported. This was attributed to favorable clinical and angiographic baseline variables and a better response to fibrinolysis. During follow-up infarct artery reocclusion is an important prognosticator. We studied the effects of smoking on reocclusion and long-term cardiac outcome after successful fibrinolysis. Methods In the Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis trials (APRICOT-1 and -2) 499 STEMI patients with an open infarct artery \48 h after fibrinolysis received randomized antithrombotic treatment until 3-month follow-up angiography. Five-year clinical follow-up was complete. Results Current smokers (317 patients, 64%) had favorable clinical (age 54 vs. 60 years, P \ 0.01) and angiographic (single vessel disease 61% vs. 49%, P = 0.02) baseline characteristics. Reocclusion rates were 21% (67/317) in smokers versus 32% (59/182) in nonsmokers (P \ 0.01). Five-year infarct-free cardiac survival did not differ: 82% vs. 85%. Reocclusion (HR 2.41, 95%CI 1.05-5.56, P = 0.04) independently predicted cardiac mortality. Smoking was independently associated with a reduced risk of reocclusion (OR 0.58, 95%CI 0.37-0.91, P = 0.02), but not with improved 5-year cardiac outcome (HR 1.34, 95%CI 0.79-2.25, P = ns). Conclusions After successful fibrinolysis, smoking is independently associated with a more than 40% reduced risk of reocclusion, which is an independent predictor of adverse outcome. However, even with more favorable baseline characteristics smokers did not have improved 5-year cardiac outcome in this low-risk population.

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Section: Smoking and Reocclusionsupporting

confidence: 60%

Section: Smoking and Reocclusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Notably, most reocclusions occur without clinical reinfarction [12][13][14]. Even in these cases, reocclusion has adverse impact on recovery of left ventricular function [15].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The smoker’s paradox after successful fibrinolysis: reduced risk of reocclusion but no improved long-term cardiac outcome

Kievit

Brouwer

Veen

et al. 2008

J Thromb Thrombolysis

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“…In the study by Brouwer et al, 20 248 (87%) of 284 patients with a patent IRA within 48 hours after thrombolysis for acute MI underwent systematic 3-month angiographic follow-up; late reocclusion was observed in 71 patients (29%). Clinical follow-up was obtained at a median of 2.6 years.…”

Section: Late Reocclusion and Long-term Survivalmentioning

confidence: 99%

Angiographically Documented Late Reocclusion After Successful Coronary Angioplasty of an Infarct-Related Lesion Is a Powerful Predictor of Long-Term Mortality

et al. 1999

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Background-Late reocclusion of an infarct-related artery (IRA) that was patent in the early days after acute myocardial infarction (MI) is a frequent event; the reocclusion rate may be as high as 30%. Few studies have been designed to analyze the impact of late reocclusion of the IRA on late survival. Methods and Results-We studied 528 patients who all had a patent IRA after a successful PTCA procedure 10Ϯ6 days after MI and who underwent systematic 6-month angiographic follow-up to assess late patency of the IRA. We compared long-term survival of patients with and without late reocclusion. Based on the results of 6-month follow-up angiography, 2 groups of patients were defined: (1) 90 patients (17%) with reocclusion (Thrombolysis In Myocardial Infarction [TIMI] flow 0 or 1) and (2) 438 patients (83%) without reocclusion. Long-term clinical follow-up was obtained for all 528 patients at a median of 5.7 years after follow-up angiography (6.4 years after PTCA). The overall actuarial 8-year total mortality rate was 13%. At the end of follow-up, there were 35 deaths (8%) among the 438 patients without reocclusion and 18 deaths (20%) among the 90 patients with reocclusion (Pϭ0.002). The actuarial 8-year total mortality rate was 10% in patients without reocclusion and 28% in patients with reocclusion (Pϭ0.0003). The actuarial cardiovascular mortality rate was 7% in patients without reocclusion and 25% in patients with reocclusion (PϽ0.0001).The impact of reocclusion on long-term mortality was greater in patients with anterior MI. Conclusions-Late IRA patency is strongly associated with long-term survival after MI. These observations should encourage prospective studies to evaluate the impact of strategies designed to prevent late reocclusion in postinfarction patients. (Circulation. 1999;99:2243-2250.)

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Safety of coronary stenting early after thrombolysis in patients with acute myocardial infarction: One‐ and six‐month clinical and angiographic evolution

Fernández‐Avilés

Alonso

Gimeno

et al. 2002

Cathet Cardio Intervent

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To determine the feasibility and safety of early posthrombolysis coronary stenting and the incidence of further reocclusion, we followed 99 consecutive patients with acute myocardial infarction thrombolyzed with rt-PA 2.0 +/- 0.8 hr after onset. Culprit artery was stented 14.0 +/- 7.0 hr after thrombolysis. All patients underwent clinical and angiographic follow-up at 1 and 6 months. Angiographic success was achieved in 99% of cases. Neither major cardiac events nor bleeding or vascular complications occurred during hospital stay. At 30 days, no events occurred and normal flow persisted in all stented arteries. At 6 months, only one artery reoccluded (1%), resulting in a nonfatal reinfarction. Restenosis rate was 21%. Contribution of the infarcted area to left ventricular function significantly increased from baseline to 30-day and to 6-month evaluations. Thus, early posthrombolysis stenting is a safe strategy with a low reocclusion rate, which seems to allow functional recovery of the infarcted area. Further studies are necessary to define its impact on survival and cost-effectiveness.

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Adverse long-term effects of reocclusion after coronary thrombolysis

Cited by 40 publications

References 27 publications

The smoker’s paradox after successful fibrinolysis: reduced risk of reocclusion but no improved long-term cardiac outcome

The smoker’s paradox after successful fibrinolysis: reduced risk of reocclusion but no improved long-term cardiac outcome

Angiographically Documented Late Reocclusion After Successful Coronary Angioplasty of an Infarct-Related Lesion Is a Powerful Predictor of Long-Term Mortality

Safety of coronary stenting early after thrombolysis in patients with acute myocardial infarction: One‐ and six‐month clinical and angiographic evolution

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