INFLUENCE OF SYSTEMIC ARTERIAL-HYPERTENSI ON ON MIDTERM SURVIVAL IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION TREATED WITH THROMBOLYTIC DRUGS

BACKGROUND: The purpose of this study was to asses the effect of syste mic arterial hypertension on mid-term survival of patients with acute myocardial infarction who received thrombolytic treatment. PATIENTS AN D METHOD: We studied 202 consecutives patients with acute myocardial i nfarction, admitted in the Coronary Care Unit of the Hospital Xeral de Galicia who received intravenous thrombolytic therapy within six hour s from the onset of symptoms. The thrombolytics used were: urokinase ( 79.7%), rt-PA (9.9%), streptokinase (4.9%) and APSAC (5.5%). Left hear t catheterization with coronary angiography was performed in 162 patie nts at 2 weeks after infarction. Patency of the infarction-related art ery (IRA) was classified according to Thrombolysis in Myocardial Infar ction (TIMI) criteria. A patent artery was defined as having TIMI grad es 2 or 3 antegrade flow. RESULTS: Systemic arterial hypertension was found in 34.7% of patients. IRA patency (TIMI 2-3) was demonstrated in the 75.3% of the patients. Early mortality (first month) was 5.4%. Mu ltivariate analysis identified cardiogenic shock as the only variable with independent predictive value for early mortality. Mean follow-up was for 24 +/- 19 months. Late mortality was 5.2% and cardiac death oc curred in 4.2% of patients. Reinfarction occurred in 3.1% of patients. Congestive heart failure, arterial hypertension and reinfarction adve rsely affected prognosis. Actuarial survival at the end of follow-up p eriod was significantly lower in patients with systemic arterial hyper tension (70.4% vs 85.9%; p < 0.05). CONCLUSIONS: These data suggest th at systemic arterial hypertension adversely affects mid-term prognosis in patients with acute myocardial infarction who received thrombolyti c treatment.