FREQUENCY OF ACHIEVING OPTIMAL REPERFUSION WITH THROMBOLYSIS IN ACUTEMYOCARDIAL-INFARCTION (ANALYSIS OF 4 GERMAN MULTICENTER STUDIES)

Patients from 4 German multicenter studies on thrombolysis in acute my ocardial infarction (AMI) were retrospectively evaluated to assess the incidence of optimal reperfusion, defined as a completely perfused in farct vessel after 90 minutes, without subsequent death or reinfarctio n, and without reocclusion or deterioration of flow in control angiogr ams. Of 907 patients with a 90-minute angiogram, 75% had an open infar ct vessel by conventional definition (perfusion grade 2 or 3 according to the criteria of the Thrombolysis in Myocardial Infarction [TIMI] s tudy). However, only 62% had TIMI grade 3 complete perfusion. Of the 5 61 patients with such primary treatment success, 106 (19%) had seconda ry treatment failure by death, reinfarction, or subtotal or total reoc clusion of the infarct vessel. In a subset of 668 patients with a firs t angiogram after so minutes, conventional patency was 70%, complete p erfusion 51%, and an optimal perfusion result was achieved in only 42% . The efficacy of thrombolysis in AMI is substantially overestimated b y conventional 90-minute patency rates.