Key result
Among patients with recent myocardial infarction and LVEF ≤40%, the 67.1% who did not receive thrombolytic therapy had a higher baseline risk for subsequent adverse cardiovascular events.
Why the study?
Does clinical selection for thrombolytic therapy in acute myocardial infarction result in a skewed population for subsequent adverse cardiovascular events?
Observational (n=2,231)
Yes
Does clinical selection for thrombolytic therapy in acute myocardial infarction result in a skewed population for subsequent adverse cardiovascular events?
Patients with acute myocardial infarction and left ventricular dysfunction who are judged clinically unsuitable for thrombolytic therapy represent a higher-risk population for adverse cardiovascular events.
Answers are grounded in this paper and cite their sources.
Non-thrombolyzed post-MI patients with LVEF ≤40% carry higher event risk; confirms selection bias limiting trial generalizability.
OBJECTIVE: To determine whether clinical selection for thrombolytic therapy for acute myocardial infarction results in a skewed population for subsequent adverse cardiovascular events. DESIGN: A comparison of the clinical features of the patients in the Survival and Ventricular Enlargement Study who either had or had not received thrombolytic therapy was conducted in both univariate and multiple logistic regression analyses. SETTING: Hospitalized patients experiencing acute myocardial infarction from 112 broadly representative, private, academic, and government hospitals in the United States and Canada. PATIENTS: All patients in the Survival and Ventricular Enlargement Study had had a recent myocardial infarction (less than 16 days) and had a left ventricular ejection fraction of 40% or less. INTERVENTION: Thrombolytic therapy was administered to 733 patients and was not given to 1498. MAIN OUTCOME MEASURES: The comparisons with respect to use of thrombolytic therapy were formulated after the completion of enrollment and indicated that the majority of patients did not receive thrombolytic therapy. RESULTS: The 1498 (67.1%) patients who did not receive thrombolytic therapy were at higher risk (older age, lower functional capacity, greater likelihood of a history of prior myocardial infarction, angina, diabetes, and hypertension) for subsequent cardiovascular events and, as anticipated, were more likely to have concomitant gastrointestinal and neurological diseases. A multiple logistic regression analysis indicated that older age, prior myocardial infarction, impaired functional status, employment status, diabetes, and neurological diseases were predictors of use of thrombolytic therapy. CONCLUSION: Although the Survival and Ventricular Enlargement Study population was selected for left ventricular dysfunction, the majority of patients who currently are judged clinically as unsuitable for thrombolytic therapy have a higher risk for adverse cardiovascular events.
No takes yet. Share an insight, caveat, or question.
Marc A. Pfeffer (1991) conducted an observational in Acute myocardial infarction with left ventricular dysfunction (n=2,231). Thrombolytic therapy vs. No thrombolytic therapy was evaluated on Predictors of use of thrombolytic therapy and baseline clinical features. Among patients with recent myocardial infarction and LVEF ≤40%, the 67.1% who did not receive thrombolytic therapy had a higher baseline risk for subsequent adverse cardiovascular events.
Synapse has enriched 10 related papers. Consider them for comparative context: