Infarct vessel status after intravenous tissue plasminogen activator and acute coronary angioplasty: prediction of clinical outcome

Am Heart J. 1988 Jan;115(1 Pt 1):1-7. doi: 10.1016/0002-8703(88)90510-8.

Abstract

To determine the risk of arterial reocclusion or recurrent ischemia after acute intervention in myocardial infarction, we analyzed the results of coronary arteriography performed acutely and at 1 week in 50 consecutive patients who received acute intervention. Successful recanalization of the infarct vessel was achieved in 46 (92%) patients after therapy with intravenous tissue plasminogen activator, percutaneous coronary angioplasty, or both. Follow-up angiography in 44 showed early reocclusion in 10 patients (23%). Intermittent patency during acute arteriography was always associated with reocclusion; suboptimal (Thrombolysis in Myocardial Infarction [TIMI] class 2) flow was associated with a 50% rate of reocclusion. Although residual stenosis of greater than 50% alone was not predictive of rethrombosis, 90% of all reocclusions were associated with either stenosis greater than 50%, TIMI 2 flow, or intermittent patency. Absence of these angiographic risk factors predicted a 95% patency rate at follow-up. In-hospital cardiac complications occurred in 17 of 23 (74%) patients with residual stenosis of greater than 50% (death in four, ischemia in 13), and late revascularization was required in 53% of survivors. Only 15% of the group with less than 50% stenosis had an in-hospital ischemic event (p less than 0.001). Thus, after acute intervention, an infarct vessel with intermittent patency or suboptimal flow is associated with a high rate of reocclusion. Residual stenosis greater than or equal to 50% appears to predict a high incidence of negative in-hospital clinical outcomes and the need for subsequent revascularization.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Angioplasty, Balloon*
  • Coronary Angiography
  • Coronary Vessels*
  • Exercise Test
  • Female
  • Follow-Up Studies
  • Humans
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / therapy*
  • Prognosis
  • Random Allocation
  • Recurrence
  • Tissue Plasminogen Activator / administration & dosage
  • Tissue Plasminogen Activator / therapeutic use*
  • Vascular Patency*

Substances

  • Tissue Plasminogen Activator