Aspirin versus coumadin in the prevention of reocclusion and recurrent ischemia after successful thrombolysis: a prospective placebo-controlled angiographic study. Results of the APRICOT Study.

Meijer, A.; Verheugt, Freek W.A.; Werter, C. J. P. J.; Lie, Kong I.; Pol, Joop M.J. van der; Eenige, M. J. van

doi:10.1161/01.cir.87.5.1524

Cited by 180 publications

(82 citation statements)

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“…Three months after successful thrombolytic therapy, the reocclusion rate may be as high as 30%. 10,11 High reocclusion rates have also been documented 6 months after PTCA of an IRA. 12,13 Few studies have been designed to analyze the impact of late reocclusion of the IRA on long-term prognosis.…”

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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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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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“…The study protocols of the APRICOT-1 (1987)(1988)(1989)(1990)(1991) and APRICOT-2 (1995APRICOT-2 ( -2000 trials have been reported in detail previously [17,18].…”

Section: Protocolmentioning

confidence: 99%

“…In APRICOT-1 reocclusion was defined as ECSG grade 4 (91-99% diameter stenosis, no complete filling within 3 cycles) or grade 5 stenosis (total occlusion with or without collateral filling) [17]. In APRICOT-2 the definition of reocclusion was TIMI flow grade 2 or less [18].…”

Section: Cardiac Catheterizationmentioning

confidence: 99%

“…Anatomical reocclusions were defined as ECSG grade 5 and TIMI flow 0 or 1, respectively. An ischemia-guided revascularization strategy was adopted [17]. If coronary angioplasty was performed before the planned repeat angiography, the patency status of the infarct artery before wire crossing was scored as follow-up endpoint.…”

Section: Cardiac Catheterizationmentioning

confidence: 99%

“…In the angiographic follow-up studies APRICOT-1 and APRICOT-2 the effect of different antithrombotic regimens on 3-month reocclusion was studied in patients with a patent infarct artery after fibrinolysis [17,18]. For the present analysis we assessed differences in clinical and angiographic baseline variables between smokers and nonsmokers and the effect of smoking on reocclusion and short-and long-term cardiac outcome.…”

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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Optimal Anticoagulation Therapy in Patients With Valvular Heart Disease or Atrial Fibrillation

McLeod¹

2009

Arch Intern Med

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Aspirin versus coumadin in the prevention of reocclusion and recurrent ischemia after successful thrombolysis: a prospective placebo-controlled angiographic study. Results of the APRICOT Study.

Cited by 180 publications

References 19 publications

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

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

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

Optimal Anticoagulation Therapy in Patients With Valvular Heart Disease or Atrial Fibrillation

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