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Non–Q-wave myocardial infarction following thrombolytic therapy: a comparison of outcomes in patients randomized to invasive or conservative post-infarct assessment strategies in the Veterans Affairs Non–Q-Wave Infarction Strategies In-Hospital (VANQWISH) trial

Laura F. Wexler, MD, FACC^*, Alvin S. Blaustein, MD, Philip W. Lavori, PhD, Kenneth G. Lehmann, MD, Michael Wade, MS^||, William E. Boden, MD^{|| **} for the Veterans Affairs Non–Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators^¶

^* Veterans Affairs Medical Center and the University of Cincinnati, Cincinnati, Ohio, USA
Veterans Affairs Medical Center, Houston, Texas, USA
Department of Veterans Affairs Cooperative Studies Program Coordinating Center, Palo Alto, California, USA
Veterans Affairs Medical Center, Seattle, Washington, USA
^|| State University of New York Health Science Center, Syracuse, New York, USA
^** Hartford Hospital, Hartford, Connecticut, USA

View larger version (13K): [in a new window]   Figure 1 Kaplan-Meier analysis of the probability of event-free survival in patients who developed non–Q-wave myocardial infarction following thrombolytic therapy (solid line) or spontaneously, i.e., in the absence of thrombolytic therapy (dashed line). The events included in this analysis were death and recurrent nonfatal myocardial infarction. The Cox proportional-hazards ratio for post-thrombolytic as compared with spontaneous non–Q-wave myocardial infarction was 0.92 (95% confidence interval, 0.6 to 1.40), adjusted for age, history of diabetes and prior myocardial infarction, and maximum creatine kinase level.

View larger version (13K): [in a new window]   Figure 2 Kaplan-Meier analysis of the probability of survival in patients who developed non–Q-wave myocardial infarction following thrombolytic therapy (solid line) or spontaneously, i.e., in the absence of thrombolytic therapy (dashed line). Death from any cause was included in this analysis. The Cox proportional-hazards ratio for post-thrombolytic as compared with spontaneous non–Q-wave myocardial infarction was 0.65 (95% confidence interval, 0.33 to 1.27), adjusted for age, history of diabetes, prior myocardial infarction, peripheral vascular disease and maximum creatine kinase level.

View larger version (14K): [in a new window]   Figure 3 Kaplan-Meier analysis of the probability of event-free survival according to strategy group in patients who developed non–Q-wave myocardial infarction following thrombolytic therapy. The events included in this analysis were death and recurrent nonfatal myocardial infarction. The Cox proportional-hazards ratio for the conservative (ischemia-guided) strategy as compared with the routine invasive strategy was 0.58 (95% confidence interval, 0.28 to 1.28).

View larger version (13K): [in a new window]   Figure 4 Kaplan-Meier analysis of the probability of survival according to strategy group in patients who developed non–Q-wave myocardial infarction following thrombolytic therapy. Death from any cause was included in the analysis. The Cox proportional-hazards ratio for the conservative (ischemia-guided) strategy as compared with the routine invasive strategy was 0.18 (95% confidence interval, 0.04 to 0.83).