ADVERSE LONG-TERM EFFECTS OF REOCCLUSION AFTER CORONARY THROMBOLYSIS

被引:36
作者
BROUWER, MA
BOHNCKE, JR
VEEN, G
MEIJER, A
VANEENIGE, MJ
VERHEUGT, FWA
机构
[1] UNIV NIJMEGEN HOSP, DEPT CARIOL, 6500 HB NIJMEGEN, NETHERLANDS
[2] FREE UNIV AMSTERDAM HOSP, DEPT CARDIOL, AMSTERDAM, NETHERLANDS
关键词
D O I
10.1016/0735-1097(95)00355-X
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives. This study sought to assess the long term clinical consequences of reocclusion after coronary thrombolysis. Background. After acute myocardial infarction successfully treated with thrombolysis, reocclusion occurs in similar to 30% of patients and leads to poorer in-hospital outcome. However, the long-term effects of reocclusion are unknown. Methods. Three hundred patients with no history of coronary surgery and with a patent infarct-related artery at coronary angiography within 48 h after thrombolysis were enrolled in the Antithrombotics in the Prevention of Reocclusion in Coronary Thrombolysis (APRICOT) trial. At a mean (+/-SD) of 77 +/- 23 days after thrombolysis, 248 patients (87%) underwent follow-up angiography. Reocclusion was observed in 71 (29%) of 248 patients. To compare outcome between 71 patients with and 177 without reocclusion an analysis of event-free survival, defined as a clinical course without death, reinfarction and revascularization, was performed. Results. Over a 3-year follow-up period, event-free survival was significantly better in patients without reocclusion: At 1 year it was 63% for patients with and 83% for those without reocclusion (p < 0.001). In the first year, two or more cardiac-related events occurred in 24% of patients with and 6% of those without reocclusion (p < 0.001). Patients with reocclusion had a markedly higher reinfarction and revascularization rate. At 1 gear the reinfarction rate,vas 23% for patients with and 5% for those without reocclusion (p < 0.001). Conclusions. This analysis shows the adverse influence of reocclusion on long-term clinical outcome in relation to reinfarction and need for revascularization. To further optimize prognosis after thrombolysis, prevention of reocclusion should become a main priority. Future research should focus on the criteria and timing of elective revascularization procedures in the prevention of coronary reocclusion.
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页码:1440 / 1444
页数:5
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