Key result
Successful fibrinolysis was strongly associated with a decreased risk of 2-year all-cause death compared with failed fibrinolysis (8.5% vs. 29.0%, HR 0.27).
Why the study?
Data on fibrinolytic therapy use for STEMI and long-term clinical outcomes in developing countries were limited.
Does successful fibrinolysis improve 2-year survival in STEMI patients compared to failed fibrinolysis?
Observational (n=1,823)
Yes
Does successful fibrinolysis improve 2-year survival in STEMI patients compared to failed fibrinolysis?
Hazard Ratio: 0.27 (95% CI 0.2–0.35)
Absolute Event Rate: 8.5% vs 29%
p-value: p=<0.001
In a large Chinese registry of STEMI patients treated with fibrinolysis, successful clinical reperfusion was achieved in 78.3% and was associated with a 73% relative reduction in 2-year all-cause mortality compared to failed fibrinolysis.
Successful fibrinolysis links to lower 2-year STEMI mortality; leaves open optimal real-world implementation in developing countries.
BACKGROUND: Data on fibrinolytic therapy use for ST-segment elevation myocardial infarction (STEMI) and long-term clinical outcomes in developing countries are limited. We aimed to investigate the management and 2-year mortality of fibrinolytic-treated patients in China. METHODS: A total of 19,112 patients with STEMI from 108 hospitals participated in the China Acute Myocardial Infarction registry between January 2013 and September 2014. We investigated the 2-year all-cause mortality among patients treated with fibrinolysis. Non-invasive clinical indexes were used to diagnose successful fibrinolysis or not. RESULTS: Only 1823 patients (9.5%) enrolled in the registry underwent fibrinolysis and 679 (37.2%) could be treated within 3 h after symptom onset. The overall use of rescue percutaneous coronary intervention was 8.9%. Successful fibrinolysis, which could be achieved in 1428 patients (78.3%), was related to types of fibrinolytic agents, symptom to needle time, infarction site, and Killip class. Follow-up data were available for 1745 patients (95.7%). After multivariate adjustment, successful fibrinolysis was strongly associated with a decreased risk of death compared with failed fibrinolysis at 2 years (8.5% vs. 29.0%, hazard ratio: 0.27, 95% confidence interval: 0.20-0.35). CONCLUSION: Within a minority of STEMI patients in the CAMI registry underwent fibrinolysis, most of them could achieve successful clinical reperfusion, presenting a much benign 2-year survival outcome than those with failed fibrinolysis. Quality improvement initiatives focusing on fibrinolysis are warranted to achieve its promise fully. TRIAL REGISTRATION: URL: https// www. CLINICALTRIALS: gov . Unique identifier: NCT01874691. Registered 11/06/2013.
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Wu et al. (2023) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=1,823). Successful fibrinolysis vs. Failed fibrinolysis was evaluated on 2-year all-cause death (HR 0.27, 95% CI 0.20-0.35, p=<0.001). Successful fibrinolysis was strongly associated with a decreased risk of 2-year all-cause death compared with failed fibrinolysis (8.5% vs. 29.0%, HR 0.27).
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