TY - JOUR
T1 - Coronary angioplasty performed within the thrombolysis in myocardial infarction II study
AU - Baim, Donald S.
AU - Diver, Daniel J.
AU - Feit, Frederick
AU - Greenberg, Mark A.
AU - Holmes, David R.
AU - Weiner, Bonnie H.
AU - Williams, David O.
AU - Schweiger, Marc J.
AU - Brown, B. Greg
AU - Frederick, Margaret M.
AU - Knatterud, Genell L.
AU - Braunwald, Eugene
PY - 1992/1
Y1 - 1992/1
N2 - Background. Percutaneous transluminal coronary angioplasty (PTCA) of the infarct-related artery was performed within 42 days of recombinant tissue-type plasminogen activator (rt-PA) administration in 1,414 of the 3,534 patients who participated in the Thrombolysis In Myocardial Infarction (TIMI) II study. Primary angiographic success was obtained in 88.7%, with bypass surgery within 24 hours in 3.3% and death within 24 hours in 0.7% of patients. By 1 year, 25.1% of the 1,414 patients had sustained one or more adverse outcomes including death (3.6%), reinfarction (8.4%), or the need for further revascularization (20%). Methods and Results. Despite these generally favorable results, multivariate testing identified several anatomic and clinical subgroups as having an increased risk ratio (RR) for adverse outcome: Unsuccessful PTCA was more common in patients undergoing protocol-assigned PTCA within 2 hours of rt-PA administration (RR, 2.7;p<0.001) and in patients over age 70 years (RR, 1.7; p=0.034). The need for further revascularization within 1 year was increased in the 30.4% of patients with multivessel disease (RR, 2.5;p<0.001), patients with prior angina (RR, 1.4;p=0.006), or those undergoing ischemia-driven PTCA within 15 hours of rt-PA administration (RR, 1.7; p=0.022). The risk of death or recurrent infarction within 1 year was increased by the presence of multivessel disease (RR, 1.6; p=0.007) or prior angina (RR, 1.5; p=0.014). Conclusions. These observations do not necessarily apply to patients undergoing primary PTCA (or PTCA after other thrombolytic agents); however, they do offer a unique yardstick against which to evaluate the results of PTCA in myocardial infarction.
AB - Background. Percutaneous transluminal coronary angioplasty (PTCA) of the infarct-related artery was performed within 42 days of recombinant tissue-type plasminogen activator (rt-PA) administration in 1,414 of the 3,534 patients who participated in the Thrombolysis In Myocardial Infarction (TIMI) II study. Primary angiographic success was obtained in 88.7%, with bypass surgery within 24 hours in 3.3% and death within 24 hours in 0.7% of patients. By 1 year, 25.1% of the 1,414 patients had sustained one or more adverse outcomes including death (3.6%), reinfarction (8.4%), or the need for further revascularization (20%). Methods and Results. Despite these generally favorable results, multivariate testing identified several anatomic and clinical subgroups as having an increased risk ratio (RR) for adverse outcome: Unsuccessful PTCA was more common in patients undergoing protocol-assigned PTCA within 2 hours of rt-PA administration (RR, 2.7;p<0.001) and in patients over age 70 years (RR, 1.7; p=0.034). The need for further revascularization within 1 year was increased in the 30.4% of patients with multivessel disease (RR, 2.5;p<0.001), patients with prior angina (RR, 1.4;p=0.006), or those undergoing ischemia-driven PTCA within 15 hours of rt-PA administration (RR, 1.7; p=0.022). The risk of death or recurrent infarction within 1 year was increased by the presence of multivessel disease (RR, 1.6; p=0.007) or prior angina (RR, 1.5; p=0.014). Conclusions. These observations do not necessarily apply to patients undergoing primary PTCA (or PTCA after other thrombolytic agents); however, they do offer a unique yardstick against which to evaluate the results of PTCA in myocardial infarction.
KW - Clinical trials
KW - Percutaneous transluminal coronary angioplasty
KW - TIMI-II Study
KW - rt-PA
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U2 - 10.1161/01.CIR.85.1.93
DO - 10.1161/01.CIR.85.1.93
M3 - Article
C2 - 1728490
AN - SCOPUS:0026528163
SN - 0009-7322
VL - 85
SP - 93
EP - 105
JO - Circulation
JF - Circulation
IS - 1
ER -