BENEFIT OF THROMBOLYTIC THERAPY TS SUSTAINED THROUGHOUT 5 YEARS AND IS RELATED TO TIMI PERFUSION GRADE 3 BUT NOT GRADE 2 FLOW AT DISCHARGE

Background Long-term follow-up in patients treated with thrombolysis f or acute myocardial infarction thus far has been reported in a few stu dies only, and no long-term follow-up is available for patients who un derwent additional percutaneous transluminal coronary angioplasty (PTC A). This report describes 5-year survival as collected in patients who received placebo, recombinant tissue plasminogen activator (rTPA), or rTPA with additional immediate PTCA in two European Cooperative Study Group trials. Determinants for long-term survival were assessed in 10 43 patients discharged alive. Methods and Results Five-year follow-up information on mortality was collected. Hospital mortality was lower a fter rTPA than placebo (2.5% versus 5.7%, P=.04) and higher after rTPA with immediate PTCA compared with rTPA without additional interventio n (6.0% versus 2.2%, P=.07). Of the 1043 hospital survivors, data were available for 923 patients, of whom 109 died. In the placebo group, m ortality after hospital discharge was 10.7% versus 11.0% in the compar ative rTPA group. The patients treated with rTPA and immediate PTCA ha d a mortality rate of 10.5% versus 8.9% in the rTPA group without PTCA (all P=NS). Significant determinants of mortality in multivariate pro portional hazards analysis were enzymatic infarct size, indicators of residual left ventricular function, number of diseased vessels and TIM I perfusion grade at discharge. Patients with TIMI grade 2 flow had mo rtality rates similar to those with TIMI flow grades 0 and 1, while pr ognosis was better in patients with TIMI flow grade 3. Conclusions The initial in-hospital benefit of thrombolysis with intravenous rTPA is maintained throughout 5 years, with no early or late beneficial effect of systematic immediate PTCA. Enzymatic infarct size, left ventricula r function, and extent of coronary artery disease are predictors for l ong-term survival. TIMI perfusion grade 2 at discharge should be consi dered as an inadequate result of therapy.