Reperfusion therapy for acute myocardial infarction: can the improvement in early survival be extended over time?

Werf, F. van der

doi:10.1053/euhj.1999.1515

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…It is worth emphasizing the importance of those results, because they were obtained in patients of the SUS, from the periphery of the city of São Paulo, involving the municipal and federal public health care systems. In addition, they confirm recent publications showing that organizing a myocardial infarction network determines an immediate improvement in outcomes, which motivated an on-going study (STREAM study), comparing directly pharmacoinvasive therapy versus primary PTCA [27][28][29][30][31][32][33][34][35]36 .…”

Section: Discussionsupporting

confidence: 74%

Rede de infarto com supradesnivelamento de ST: sistematização em 205 casos diminui eventos clínicos na rede pública

Caluza¹,

Barbosa

Gonçalves

et al. 2012

Arq. Bras. Cardiol.

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Section: Discussionsupporting

confidence: 74%

Rede de infarto com supradesnivelamento de ST: sistematização em 205 casos diminui eventos clínicos na rede pública

Caluza¹,

Barbosa

Gonçalves

et al. 2012

Arq. Bras. Cardiol.

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“…The early survival advantage produced by thrombolytic therapy in patients with evolving AMI [20, 21, 22, 23, 24, 25]was maintained during long-term follow-up of 3–5 years [26, 27, 28, 29]and even of 10–14 years [15, 16, 30]. There was no additional benefit after hospital discharge, although such a benefit could be expected due to a reduction in infarct size and improved left ventricular function in successfully reperfused patients [16, 31, 32]. The lack of an additional contribution of thrombolysis to survival after the early post-infarct period in the randomized controlled trials is not well understood.…”

Section: Discussionmentioning

confidence: 99%

“…The lack of an additional contribution of thrombolysis to survival after the early post-infarct period in the randomized controlled trials is not well understood. It could be partially explained by higher re-infarction rates in thrombolyzed patients compared to controls [16, 31, 32]. In addition, it is possible that thrombolytic therapy is life-saving for critically ill patients whose counterparts in the control group die during the initial hospitalization, so that the former constitute a high-risk group exposed to increased mortality during follow-up [31, 32].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Mortality Rates Reflect Progressive Prognostic Benefits of Thrombolysis in Patients with First Acute Myocardial Infarction

Shapira

Pines²,

Goldbourt

et al. 2000

Cardiology

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This community nonrandomized study comprised a consecutive cohort of 1,545 (81% males) ≤65-year-old patients who survived a first acute myocardial infarction (AMI). The all-cause 4- to 5-year mortality rate was 9% (80% cardiac). Univariate analysis revealed that older age, female gender, hypertension, diabetes, not undergoing thrombolysis, higher Killip class, preinfarction heart disease, peripheral vascular disease (PVD) and chronic obstructive lung disease (COLD) were significantly associated with increased mortality. Multivariate analyses disclosed the latter five parameters as being independent predictors of mortality. Our results show that patients undergoing thrombolysis enjoyed a progressive prognostic benefit over time. The independent contribution of PVD and COLD to long-term mortality is highlighted, in addition to the contribution of thrombolytic therapy, Killip class, and heart disease prior to infarction as being important predictors of long-term mortality in patients with a first AMI.

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A Review of the Long Term Effects of Thrombolytic Agents

Domburg

Boersma

Simoons

2000

Drugs

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Unequivocal evidence exists that reperfusion therapy, when given within 12 hours after onset of symptoms, saves the lives of patients with acute myocardial infarction (MI). As a result, the routine use of such treatment has increased rapidly since the mid-1980s but the rates of utilisation have been relatively static over the last decade at approximately 50% of patients with acute MI. The major question arising in this respect is: is the benefit of reperfusion therapy, which is achieved during the acute phase in evolving MI, maintained on the long term? The main thrombolytic agents currently in use are streptokinase, alteplase, anistreplase, urokinase and reteplase. Other studies compared coronary angioplasty with thrombolytic therapy and investigated the effect of an additional angioplasty procedure after failed thrombolytic therapy. Furthermore, several studies have been performed to investigate the effect of initiation of reperfusion therapy before hospital admission. It is generally agreed that, in particular, patients receiving early treatment within 6 hours from onset of symptoms and patients with ST elevation benefit most from thrombolytic therapy. One would theoretically expect that infarct size reduction achieved by reperfusion therapy would also have a beneficial effect on the survival, not only during the hospital stay but also afterwards, resulting in diverging survival curves between patients who received reperfusion therapy and those who did not. However, the survival curves run perfectly parallel after hospital discharge from 1 year up to year 10 in most studies. The explanation for a lack of extra benefit may be a net result of combining the results of several subgroups. For example, thrombolytic therapy results in more frequent reinfarction especially in the first year, or patients with low left ventricular ejection fraction could survive the hospital phase because of effective thrombolytic therapy, but they survive at high risk. Although several trials suggest that primary percutaneous transluminal coronary angioplasty may be more beneficial than thrombolytic therapy in acute MI, these data should be interpreted cautiously unless confirmed by larger studies with long term results. In addition, evidence exists to suggest that administration of fibrinolytic treatment, under certain conditions, before hospital admission may lead to further improvement of a patient's prognosis. Again, further investigation is warranted. The conclusion is that clear evidence exists that the early improved survival after thrombolytic therapy has been shown to be maintained beyond a decade. However, the expected theorectical additional benefit of reperfusion therapy after hospital discharge has not been observed.

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Reperfusion therapy for acute myocardial infarction: can the improvement in early survival be extended over time?

Cited by 3 publications

References 6 publications

Rede de infarto com supradesnivelamento de ST: sistematização em 205 casos diminui eventos clínicos na rede pública

Rede de infarto com supradesnivelamento de ST: sistematização em 205 casos diminui eventos clínicos na rede pública

Long-Term Mortality Rates Reflect Progressive Prognostic Benefits of Thrombolysis in Patients with First Acute Myocardial Infarction

A Review of the Long Term Effects of Thrombolytic Agents

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