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Long-term prognosis of patients undergoing thrombolysis during the acute phase of myocardial infarction

Long-term prognosis of patients undergoing thrombolysis during the acute phase of myocardial infarction

Annales de Cardiologie et d'Angeiologie 46(5-6): 303-310

Objective: The objective of this study was to analyse the long-term mortality and morbidity of a group of patients undergoing thrombolysis during the acute phase of myocardial infarction and to determine the factors influencing the prognosis. One hundred and seventy five patients (149 mean and 26 women, mean age: 54 years) were included in a randomized study, comparing the efficacy of 2 thrombolytic substances administered during the acute phase of myocardial infarction. A standard questionnaire was sent to the various attending physicians for follow-up of these 175 patients. Results: the hospital mortality was 5% (9 patients) and 14 patients (9%) died after a mean follow-up of 4.3 +- 2.1 years. The 5-year actuarial survival was 81%. Fourteen patients (8%) were lost to follow-up and 49 patients (32%) underwent surgical or percutaneous revascularization during follow-up. Revascularized patients had a significantly better survival than non-revascularized patients. The mean left ventricular ejection fraction of patients who died was lower (48% versus 71%) than that of survivors. Patients with an ejection fraction lt 40 % also had a significantly lower survival (p = 0.01). Patency of the vessel after thrombolysis was associated with a slightly better survival; this difference was not significant. The ejection fraction at 6 month was also significantly higher (60 +- 10% versus 49 +- 11%) for patients with a patent artery. Three risk factors for death or reinfarction were identified: age gt 65 years at the time of infarction, disease in more than one coronary vessel and absence of angina pectoris before infarction. The probability of a coronary accident varied from 2 to 86% according to the number of risk factors present. At the time of follow-up, 60% of patients presented hypercholesterolemia versus only 7% before infarction. 73% of patients received anticoagulant or antiaggregant treatment and 81% of patients were asymptomatic. Conclusion: The mortality and the acute and long-term morbidity of myocardial infarction remain high, as only 34% of our patients did not develop any events during follow-up, despite serious medical management and follow-up. The ejection fraction has an important prognostic value. Patient management should take the above-mentioned risk factors into account.

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Accession: 008971806

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PMID: 9295890

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