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CLINICAL STUDIES

Clinical predictors of early infarct-related artery patency following thrombolytic therapy: importance of body weight, smoking history, infarct-related artery and choice of thrombolytic regimen: the GUSTO-I experience

^a Cardiovascular Research Institute and the GUSTO-I Core Angiographic Laboratory, The George Washington University, Washington, DC, USA
^* Duke University, Durham, North Carolina, USA

Manuscript received March 7, 1997; revised manuscript received April 21, 1998, accepted May 11, 1998.

Address for correspondence: Dr. Conor F. Lundergan, Cardiovascular Research Institute & Division of Cardiology, The George Washington University Medical Center, 2150 Pennsylvania Avenue, NW, Washington, DC 20037

Objectives. The purpose of this study was to determine patient characteristics that are a priori predictors of early infarct related artery patency following thrombolytic therapy, and to provide a paradigm which may identify patients who would be most likely to achieve restoration of normal (TIMI 3) coronary flow in response to thrombolytic therapy.

Background. Restoration of infarct-related artery perfusion in acute myocardial infarction is necessary for preservation of ventricular function and mortality reduction. Clinical variables that are a priori predictors of early patency with currently available thrombolytic regimens have not been fully characterized.

Methods. The probability of early infarct-related artery patency (TIMI 3 flow) was determined by multivariable logistic regression. We determined a reduced (parsimonious) model for predicting early (90 min) infarct-related artery patency (TIMI grade 3) based on data from 1,030 patients in the GUSTO-I Angiographic study.

Results. Predictors of 90 min TIMI 3 flow are use of an accelerated t-PA regimen (vs. streptokinase containing regimens) (² = 39.1; p 0.0001), infarct related artery (RCA/Lcx vs. LAD) (² = 12.7; p = 0.0004), body weight (² = 10.3; p = 0.001) and history of smoking (² = 7.4; p = 0.007). Time from symptom onset to treatment was not significant (p = 0.71).

Conclusions. The efficacy of currently available thrombolytic regimens is chiefly dependent on choice of thrombolytic regimen, body weight, infarct-related coronary artery and smoking history. Clinical variables alone correctly predict a priori TIMI 3 flow in the infarct-related artery 64% of the time. Patients with body weights greater than 85 kg are at a significant disadvantage with regard to achieving successful thrombolysis compared to those with lesser body weights.

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