Survival and cardiac event rates in the first year after emergency coronary angioplasty for acute myocardial infarction

Richard S. Stack, Robert M. Califf, Tomoaki Hinohara, Harry R. Phillips, David B. Pryor, Charles A. Simonton, Eric B. Carlson, Kenneth G. Morris, Victor S. Behar, Yihong Kong, Robert H. Peter, Mark A. Hlatky, Christopher M. O'Connor, Daniel B. Mark

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79 Scopus citations

Abstract

One year survival and event-free survival rates were analyzed in 342 patients with acute myocardial infarction who were consecutively enrolled in a treatment protocol of early intravenous thrombolytic therapy followed by emergency coronary angioplasty. Ninety-four percent of the patients achieved successful reperfusion, including 4% with failed angioplasty whose perfusion was maintained by means of a reperfusion catheter before emergency bypass surgery. The procedural mortality rate was 1.2% and the total in-hospital mortality rate was 11%. Ninety-two percent of surviving nonsurgical patients who underwent repeat cardiac catheterization were discharged from the hospital with an open infarct-related artery. The related cumulative 1 year survival rate for all patients managed with this treatment strategy was 87%, and the cardiac event-free survival rate was 84%. The 1 year survival for hospital survivors was 98% and the infarct-free survival rate was 94%. Multivariable analysis identified the following factors as independent predictors of subsequent cardiovascular death: cardiogenic shock, greater age, lower ejection fraction, female gender and a closed infarct-related vessel on the initial coronary angiogram. Among patients with cardiogenic shock, despite a 42% in-hospital mortality rate, only 4% died during the first year after hospital discharge. Similarly, the in-hospital and 1 year postdischarge mortality rates were 19 and 4%, respectively, for patients with an initial ejection fraction <40, and 25 and 3%, respectively, for patients > 65 years. An aggressive treatment strategy including early thrombolytic therapy, emergency cardiac catheterization, coronary angioplasty and, when necessary, bypass surgery resulted in a high rate of infarct vessel patency. Long-term mortality and reinfarction rates after hospital discharge were low, even for patients in high risk subgroups.

Original languageEnglish (US)
Pages (from-to)1141-1149
Number of pages9
JournalJournal of the American College of Cardiology
Volume11
Issue number6
DOIs
StatePublished - Jun 1988

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Stack, R. S., Califf, R. M., Hinohara, T., Phillips, H. R., Pryor, D. B., Simonton, C. A., Carlson, E. B., Morris, K. G., Behar, V. S., Kong, Y., Peter, R. H., Hlatky, M. A., O'Connor, C. M., & Mark, D. B. (1988). Survival and cardiac event rates in the first year after emergency coronary angioplasty for acute myocardial infarction. Journal of the American College of Cardiology, 11(6), 1141-1149. https://doi.org/10.1016/0735-1097(88)90274-4