Recurrent ischemia after thrombolysis: Importance of associated clinical findings

Amadeo Betriu, Robert M. Califf, Xavier Bosch, Alan Guerci, Amanda L. Stebbins, N. Alejandro Barbagelata, Philip E. Aylward, Alec Vahanian, Frans Van De Werf, Eric J. Topol

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)

Abstract

Objectives. We sought to assess the incidence and clinical relevance of examination data to recurrent ischemia within an international randomized trial. Background. Ischemic symptoms commonly recur after thrombolysis for acute myocardial infarction. Methods. Patients (n = 40,848) were prospectively evaluated for recurrent angina and transient electrocardiographic (ECG) or hemodynamic changes. Five groups were developed: Group 1, patients with no signs or symptoms of recurrent ischemia; Group 2, patients with angina only; Group 3, patients with angina and ST segment changes; Group 4, patients with angina and hemodynamic abnormalities; and Group 5, patients with angina, ST segment changes and hemodynamic abnormalities. Baseline clinical and outcome variables were compared among the five groups. Results. Group 1 comprised 32,717 patients, and Groups 2 to 5 comprised 20% of patients (4,488 in Group 2; 3,021 in Group 3; 337 in Group 4; and 285 in Group 5). Patients with recurrent ischemia were more often female, had more cardiovascular risk factors and less often received intravenous heparin. Significantly more extensive and more severe coronary disease, antianginal treatment, angioplasty and coronary bypass surgery were observed as a function of ischemic severity. The 30-day reinfarction rate was 1.6% in Group 1, 6.5% in Group 2, 21.7% in Group 3, 13.1% in Group 4 and 36.5% in Group 5 (p < 0.0001); in contrast, the 30-day mortality rate was significantly lower (p < 0.0001) in Groups 1, 2 and 3 (6.6%, 5.4% and 7.7%, respectively) than in Groups 4 and 5 (21.8% and 29.1%). Conclusions. Postinfarction angina greatly increases the risk of reinfarction, especially when accompanied by transient ECG changes. However, mortality is markedly increased only in the presence of concomitant hemodynamic abnormalities.

Original languageEnglish
Pages (from-to)94-102
Number of pages9
JournalJournal of The American College of Cardiology
Volume31
Issue number1
DOIs
Publication statusPublished - 1 Jan 1998
Externally publishedYes

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