RECURRENT ISCHEMIA AFTER THROMBOLYSIS - IMPORTANCE OF ASSOCIATED CLINICAL FINDINGS

Objectives. We sought to assess the incidence and clinical relevance o f examination data to recurrent ischemia within an international rando mized trial. Background. Ischemic symptoms commonly recur after thromb olysis for acute myocardial infarction. Methods. Patients (n = 40,848) were prospectively evaluated for recurrent angina and transient elect rocardiographic (EGG) or hemodynamic changes, Five groups were develop ed: Group 1, patients with no signs or symptoms of recurrent ischemia; Group 2, patients with angina only; Group 3, patients with angina and ST segment changes; Group 1, patients with angina and hemodynamic abn ormalities; and Group 5, patients with angina, ST segment changes and hemodynamic abnormalities, Baseline clinical and outcome variables wer e compared among the five groups. Results. Group 1 comprised 32,717 pa tients, and Groups 2 to 5 comprised 20% of patients (4,488 in Group 2; 3,021 in Group 3; 337 in Group 4; and 285 in Group 5), Patients with recurrent ischemia were more often female, had more cardiovascular ris k factors and less often received intravenous heparin, Significantly m ore extensive and more severe coronary disease, antianginal treatment, angioplasty and coronary bypass surgery were observed as a function o f ischemic severity, The 30-day reinfarction rate was 1.6% in Group 1, 6.5% in Group 2, 21.7% in Group 3, 13.1% in Group 4 and 36.5% in Grou p 5 (p < 0.0001); in contrast, the 30-day mortality rate was significa ntly lower (p < 0.0001) in Groups 1, 2 and 3 (6.6%, 5.4% and 7.7%, res pectively) than in Groups 1 and 5 (21.8% and 29.1%). Conclusions. Post infarction angina greatly increases the risk of reinfarction, especial ly when accompanied by transient ECG changes, However, mortality is ma rkedly increased only in the presence of concomitant hemodynamic abnor malities. (C) 1998 by the American College of Cardiology.