What are the clinical predictors of early morbidity and mortality after thrombolytic therapy for acute myocardial infarction, and how do outcomes compare between invasive and conservative strategies in specific subgroups?
Clinical variables such as cardiogenic shock, prior myocardial infarction, and diabetes can identify subgroups of patients who may benefit differentially from invasive versus conservative management after thrombolysis for acute myocardial infarction.
The strong independent correlation of pulmonary edema/cardiogenic shock with death suggests that thrombolysis is not sufficient to improve survival in these patients. The higher mortality in patients with versus without prior AMI in the conservative strategy suggests that early catheterization and revascularization of these patients might be beneficial. Conversely, the higher mortality in diabetes without prior AMI in the invasive than in the conservative strategy suggests that early aggressive management might not be suitable in this subgroup except for clinical indications. Reinfarction was not predictable by clinical variables except by history of angina. The finding that "not current smoker" was an independent correlate with reinfarction was unexpected.
Mueller et al. (Wed,) studied this question.
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