Early and long-term clinical outcomes associated with reinfarction following fibrinolytic administration in the thrombolysis in myocardial infarction trials
C. Michael Gibson, MS, MD*,*,
Juhana Karha, MD*,
Sabina A. Murphy, MPH*,
David James, BS*,
David A. Morrow, MPH, MD*,
Christopher P. Cannon, MD*,
Robert P. Giugliano, SM, MD*,
Elliott M. Antman, MD*,
Eugene Braunwald, MD* TIMI Study Group
* Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Figure 1 (A) Kaplan-Meier curves relating short-term and long-term outcomes to recurrent myocardial infarction (MI). Most deaths among patients with early reinfarction occurred early, and the curves did not shift between 30 days and 2 years of follow-up. (B) Kaplan-Meier estimated mortality rates up to two years by in-hospital reinfarction, stratified by Thrombolysis In Myocardial Infarction risk score (TRS). Mortality was higher in patients with reinfarction in the low, intermediate, and high TRS groups. In the analysis adjusting for age, gender, anterior MI, pulse rate on admission, history of hypertension, previous angina, current smoker, previous MI, weight, and time from symptom onset to treatment, the p value was <0.001 in each of the TRS groups.
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Figure 2 Kaplan-Meier curves relating long-term outcomes (up to two years) to recurrent myocardial infarction in patients who were alive at hospital discharge. There was no difference in mortality in patients with an early reinfarction when the analysis was restricted to patients who survived the index hospitalization (p = 0.45 by log-rank).
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Figure 3 (A) Kaplan-Meier curves relating short-term and long-term outcomes (up to two years) to percutaneous coronary intervention (PCI) use during the index hospitalization. In the analysis adjusting for age, gender, anterior myocardial infarction (MI), pulse rate on admission, history of hypertension, previous angina, current smoker, previous MI, weight, and time from symptom onset to treatment, the p value was <0.001. (B) Kaplan-Meier estimated mortality rates up to two years by in-hospital PCI, stratified by Thrombolysis In Myocardial Infarction risk score (TRS). Mortality was lower in patients who underwent PCI in the low, intermediate, and high TRS groups. In the analysis adjusting for age, gender, anterior MI, pulse rate on admission, history of hypertension, previous angina, current smoker, previous MI, weight, and time from symptom onset to treatment, the p value was <0.001 in each of the TRS groups.
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Figure 4 (A) Kaplan-Meier curves relating short- and long-term outcomes (up to two years) to coronary artery bypass graft surgery (CABG) use during the index hospitalization. (B) Kaplan-Meier estimated mortality rates up to two years by in-hospital CABG, stratified by Thrombolysis In Myocardial Infarction risk score (TRS). Mortality was lower in patients who underwent CABG in the high TRS groups, with a trend toward being lower in the intermediate-risk group, but showed no difference in the low-risk score group.
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Figure 5 (A) Kaplan-Meier curves relating short- and long-term outcomes (up to two years) to revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass graft surgery [CABG]) use during the index hospitalization. (B) Kaplan-Meier estimated mortality rates up to two years by in-hospital revascularization (PCI or CABG), stratified by Thrombolysis In Myocardial Infarction risk score (TRS). Mortality was lower in patients who underwent revascularization in the low, intermediate, and high TRS groups.
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