Repeat thrombolysis and revascularization were associated with significantly lower 30-day mortality compared to conservative management (11% and 11% vs 28%, P<0.001) after initial thrombolytic therapy.
Observational (n=2,301)
Yes
Does repeat thrombolysis or revascularization reduce 30-day mortality compared to conservative measures in patients with reinfarction after thrombolytic therapy?
In patients experiencing reinfarction after initial thrombolytic therapy, active management with either repeat thrombolysis or revascularization is associated with significantly lower 30-day mortality compared to conservative management.
Absolute Event Rate: 11% vs 28%
p-value: p=<0.001
BACKGROUND: Early reinfarction after thrombolytic therapy is associated with adverse outcomes and increased mortality. Among patients with reinfarction in the 1992 Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO I) and the 1998 Assessment of the Safety of a New Thrombolytic (ASSENT 2) trials, we investigated temporal and regional differences in the use of repeat thrombolysis, revascularization (angioplasty and/or bypass surgery), or conservative measures and the outcomes of each management strategy. METHODS AND RESULTS: Data from the 4% of patients (n=2301) who experienced reinfarction after thrombolytic therapy were studied. Baseline characteristics, 30-day mortality, and incidence of total and hemorrhagic strokes were compared among the 3 treatment groups. The 30-day mortality did not differ between the repeat thrombolysis and revascularization groups (P=0.72), and it was significantly lower among patients treated by these 2 strategies than in those treated conservatively (11% and 11% versus 28%, respectively; P<0.001). Stroke rates did not differ significantly between the 3 treatment strategies (P=0.49). From 1992 to 1998, the percentage of reinfarction patients treated with repeat thrombolysis decreased from 29.3% to 18.5% in US centers and from 51.4% to 41.9% in all other centers (P<0.001). In contrast, use of revascularization procedures increased from 33.5% to 47.9% in US centers and from 8.1% to 23.0% in all other centers (P<0.001). CONCLUSIONS: Repeat thrombolysis and revascularization are associated with significantly lower mortality among reinfarction patients. Randomized trials are necessary to assess the exact risks and benefits of rethrombolysis versus interventional revascularization in this subset of high-risk patients presenting with reinfarction after thrombolytic therapy.
Barbash et al. (Tue,) conducted a observational in Reinfarction after thrombolytic therapy for acute myocardial infarction (n=2,301). Repeat thrombolysis or revascularization vs. Conservative measures was evaluated on 30-day mortality (p=<0.001). Repeat thrombolysis and revascularization were associated with significantly lower 30-day mortality compared to conservative management (11% and 11% vs 28%, P<0.001) after initial thrombolytic therapy.