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Long-term prognosis of patency of infarct-related coronary artery after thrombolytic therapy in acute myocardial infarction



Long-term prognosis of patency of infarct-related coronary artery after thrombolytic therapy in acute myocardial infarction



Zhonghua Xinxueguanbing Zazhi 24(3): 178-182



In order to investigate long-term prognostic influence of patency of the infarct-related coronary artery, 1267 cases of acute myocardial infarction after thrombolytic therapy were followed up between July, 1991 and January, 1995 from thirty six hospitals with a total follow-up rate of 84.5%. Patency of infarct-related coronary artery was assessed by uniform clinical criteria. Eight hundred and forty three patients with patency were followed up for 13908 person-months (mean 16.0 +- 10.4 months) and 424 patients without patency were followed up for 8156 person-months (mean 19.2 +- 12.2 months). Death or up to the end of March, 1995 was used as an end point. Eighteen of the 36 hospitals followed 826 patients, achieving a follow-up rate of 95.2%. Data from these 18 hospitals were analysed separately to check up the results of all the 36 hospitals. Results were similar for the 18 and all 36 hospitals. Comparison of patients with patent versus occluded infarct-related coronary artery during follow-up showed: (1) Cardiac death rate of 2.85% in patients with patency vs 4.72% in those without patency (Logrank test P gt 0.1). (2) Three-year survival rates calculated according to Kaplan-Meier curve method were 91.6% and 73.9% respectively (Logrank test P lt 0.001); however, for patients surviving the first 4 weeks after onset, three-year survival rates were 95.0% and 92.5% respectively (P gt 0.05). It was evident that patency of infarct-related coronary artery could improve long-term survival. Cardiac death rate was reduced markedly in acute stage, and continued to decrease to a lesser extent later. (3) Incidence rates of reinfarction were 5.69% and 5.90% respectively, showing no significant difference. (4) Patients with class III - IV NY-HA cardiac function occurred in 11.3% versus 17.9 (P lt 0.01), but no significant difference was found in the group of 18 hospitals (P gt 0.05). (5) On Cox regression model analysis patency of infarct-related coronary artery, recurrent infarction, age and infarct site were independent prognostic factors. Survival probability increased by 33.5% in patients with patency compared to those without patency. Survival probability decreased in 36.5% in patients with one recurrence of infarction.

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