Long-term follow-up of patients treated with intracoronary thrombolysis or percutaneous transluminal coronary angioplasty for acute myocardial infarction]

Long-term follow-up data concerning coronary patients treated for acute myocardial infarction with intracoronary thrombolysis (ICT) or percutaneous transluminal coronary angioplasty (PTCA) are sparse. In this study, the early and long-term outcomes in 95 patients undergoing only ICT (group I) and 190 patients undergoing only PTCA (group II) were retrospectively evaluated. Cardiogenic shock cases in group II were excluded from this study because of the absence of comparable shock cases in group I. The overall in-hospital mortality was 3.5% (10 patients). Treatment by reperfusion therapy during the acute phase was not a significant factor in predicting the in-hospital mortality (5.4% in group I vs 2.6% in group II), but a Forrester subset (p < 0.001) and the extent of coronary artery disease (p < 0.05) were reliable predictors. In a discrimination analysis, a Forrester subset (3, 4) was the most reliable predictor followed by age (> 70 years). Follow-up was completed for 263 of 273 (96%) hospital survivors (88 patients in group I and 185 in group II). Mean follow-up periods of groups I and II (+/- SD) were 57 +/- 35 and 23 +/- 15 months, respectively. Five-year cardiac death-free survival for hospital survivors after ICT was 87% compared with 96% after PTCA (p was not significant). In a univariate analysis, a Forrester subset (p < 0.001) and the extent of residual coronary disease on discharge from the hospital (p < 0.01) were reliable predictors of subsequent cardiovascular deaths. Multivariate analysis also identified these 2 factors as independent predictors. We concluded that the most significant determinant factor of in-hospital and long-term mortality after intervention might be a Forrester subset; namely, left ventricular function at the time of emergency admission, and that long-term survival seemed to relate to the extent of coronary artery disease on discharge from the hospital. This suggested that interventional reperfusion therapy did not necessarily improve left ventricular function at the time of hospital discharge.