Frequency of achieving optimal reperfusion with thrombolysis in acute myocardial infarction (analysis of four German multicenter studies)

• Published in: The American journal of cardiology Vol. 74; no. 1; pp. 1 - 4
• Main Authors: Vogt, Albrecht, von Essen, Rainer, Tebbe, Ulrich, Feuerer, Werner, Appel, Karl-Friedrich, Niederer, Walter, Neuhaus, Karl-Ludwig
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.1994; Elsevier Limited
• Subjects: Adult; Aged; Anistreplase - pharmacology; Anistreplase - therapeutic use; Cardiovascular disease; Female; Fibrinolytic Agents - pharmacology; Fibrinolytic Agents - therapeutic use; Humans; Logistic Models; Male; Medical research; Middle Aged; Myocardial Infarction - drug therapy; Plasminogen Activators - pharmacology; Plasminogen Activators - therapeutic use; Recombinant Proteins - pharmacology; Recombinant Proteins - therapeutic use; Recurrence; Retrospective Studies; Thrombolytic Therapy; Tissue Plasminogen Activator - pharmacology; Tissue Plasminogen Activator - therapeutic use; Treatment Failure; Urokinase-Type Plasminogen Activator - pharmacology; Urokinase-Type Plasminogen Activator - therapeutic use; Vascular Patency - drug effects
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(94)90481-2

Patients from 4 German multicenter studies on thrombolysis in acute myocardial infarction (AMI) were retrospectively evaluated to assess the incidence of optimal reperfusion, defined as a completely perfused infarct vessel after 90 minutes, without subsequent death or reinfarction, and without reocclusion or deterioration of flow in control angiograms. Of 907 patients with a 90-minute angiogram, 75% had an open infarct vessel by conventional definition (perfusion grade 2 or 3 according to the criteria of the Thrombolysis in Myocardial Infarction [TIMI] study). However, only 62% had TIMI grade 3 complete perfusion. Of the 561 patients with such primary treatment success, 106 (19%) had secondary treatment failure by death, reinfarction, or subtotal or total reocdusion of the infarct vessel. In a subset of 668 patients with a first angiogram after 60 minutes, conventional patency was 70%, complete perfusion 51%, and an optimal perfusion result was achieved in only 42%. The efficacy of thrombolysis in AMI is substantially overestimated by conventional 90-minute patency rates.