Sustained benefit at 10-14 years follow-up after thrombolytic therapy in myocardial infarction

Aims To investigate whether the benefit of thrombolytic therapy was sustain ed beyond the first decade. We report the 10-14 year outcome of 533 patient s who were randomized to treatment with intracoronary streptokinase or to c onventional therapy during the years 1980-1985, Methods and Results Derails of survival and cardiac events were obtained fr om the civil registry, from medical records or from the patient's physician . At follow-up, 158 (59%) of the 269 patients allocated to thrombolytic tre atment and only 129 (49%) of the 264 conventionally treated patients were a live. The cumulative 1-; 5- and 10-year survival rates were 91%, 81% and 69 % in patients treated with streptokinase and 84%, 71% and 59% in the contro l group, respectively (P=0.02). Reinfarction during 10 years of follow-up w as more frequent after thrombolytic therapy, particularly during the first year. Coronary bypass surgery and coronary angioplasty were more frequently performed after thrombolytic therapy. At 10 years approximately 30% of the patients were free from subsequent cardiac events. Independent determinant s of mortality were old age, indicators of impaired residual left ventricul ar function, multivessel disease and an inability to perform an exercise te st at the time of hospital discharge. Conclusion Improved survival after thrombolytic therapy is maintained beyon d the first decade. Age, left ventricular function, multivessel disease and an inability to perform an exercise test were independent predictors for l ong-term mortality, as they are predictors for early mortality.