Article

Early and long-term clinical outcomes associated with reinfarction following fibrinolytic administration in the Thrombolysis in Myocardial Infarction trials.

Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 350 Longwood Avenue, 1st Floor, Boston, MA 02115, USA.
Journal of the American College of Cardiology (impact factor: 14.16). 08/2003; 42(1):7-16. DOI:10.1016/S0735-1097(03)00506-0
Source: PubMed

ABSTRACT We hypothesized that early recurrent myocardial infarction (MI) following fibrinolytic administration would be assessed with higher mortality at both 30 days and 2 years.
Although early recurrent MI after fibrinolytic therapy has been associated with increased early mortality in the acute MI setting, its relation to long-term mortality has not been fully explored.
Mortality data were ascertained in 20,101 patients enrolled in the Thrombolysis In Myocardial Infarction (TIMI) 4, 9, and 10B and Intravenous NPA for the Treatment of Infarcting Myocardium Early (InTIME-II) acute MI trials.
The frequency of symptomatic recurrent MI during the index hospitalization was 4.2% (836/20,101). Recurrent MI during the index hospital period was associated with increased 30-day mortality (16.4% [137/836] vs. 6.2% [1,188/19,260], p < 0.001). Likewise, recurrent MI was associated with a sustained increase in mortality up to two years, even after adjustments were made for covariates known to be associated with mortality and recurrent MI (hazard ratio 2.11, p < 0.001). However, this higher mortality at 2 years was due to an early divergence in mortality by 30 days and was not due to a significant increase in late mortality between 30 days and 2 years (4.38% [31/707] vs. 3.76% [685/18,206], p = NS). Percutaneous coronary intervention during the index hospitalization was associated with a lower rate of in-hospital recurrent MI (1.6% vs. 4.5%, p < 0.001) and lower two-year mortality (5.6% vs. 11.6%, p < 0.001). Performance of coronary artery bypass graft surgery was also associated with a lower recurrent rate of MI (0.7% vs. 4.3%, p < 0.001) and lower two-year mortality rate (7.95% vs. 10.6%, p = 0.0008).
Early recurrent MI is associated with increased mortality up to two years. However, most deaths occur early, and the risk of additional deaths between the index hospital period and two years was not significantly increased among patients with recurrent MI. Percutaneous coronary intervention during the index hospitalization was associated with a lower risk of recurrent MI and a lower risk of two-year mortality.

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Keywords

30-day mortality
 
acute MI
 
additional deaths
 
fibrinolytic administration
 
higher mortality
 
in-hospital recurrent MI
 
index hospitalization
 
Infarcting Myocardium
 
long-term mortality
 
lower rate
 
lower recurrent rate
 
lower two-year mortality
 
lower two-year mortality rate
 
Mortality data
 
Myocardial Infarction
 
recurrent MI
 
recurrent myocardial infarction
 
sustained increase
 
symptomatic recurrent MI
 
two-year mortality