Key result
A deferred invasive treatment strategy significantly improved survival compared to medical treatment in patients with post-thrombolytic Q-wave myocardial infarction (HR 0.85; 95% CI 0.73-0.99; p=0.034).
Why the study?
Does deferred invasive treatment improve survival in patients with post-thrombolytic Q-wave myocardial infarction and inducible myocardial ischemia?
RCT (n=751)
randomized
Does deferred invasive treatment improve survival in patients with post-thrombolytic Q-wave myocardial infarction and inducible myocardial ischemia?
Hazard Ratio: 0.85 (95% CI 0.73–0.99)
p-value: p=0.034
A deferred invasive treatment strategy improves long-term survival compared to medical treatment in patients with inducible myocardial ischemia after a post-thrombolytic Q-wave myocardial infarction.
Supports deferred invasive strategy over medical therapy in post-thrombolytic Q-wave MI with inducible ischemia; extends RCT evidence for survival benefit.
OBJECTIVES: The aim of the present study was to assess the effect of a deferred invasive treatment strategy on long-term outcome in patients with a post-thrombolytic Q-wave myocardial infarction and inducible myocardial ischemia. DESIGN: Patients (N=751) with post-thrombolytic Q-wave myocardial infarction and inducible ischemia (angina pectoris or silent myocardial ischemia) were randomized to a deferred invasive treatment (balloon angioplasty or coronary bypass surgery) or medical treatment. Vital status and non-fatal cardiac events defined as hospitalization caused by acute cardiac events were recorded for a median of 11.4 years. RESULTS: Survival was significantly improved in patients receiving invasive treatment compared to patients treated medically (hazard ratio 0.85 (95% confidence limits 0.73-0.99), p=0.034). Subgroup analysis showed a reduction of non-fatal cardiac events and improved survival among the patients with post-infarction angina pectoris and not among the patients with silent myocardial ischemia. CONCLUSIONS: A deferred invasive treatment strategy improves survival compared to medical treatment in patients with inducible myocardial ischemia after a post-thrombolytic Q-wave myocardial infarction.
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Kofoed et al. (2010) conducted an RCT in post-thrombolytic Q-wave myocardial infarction and inducible myocardial ischemia (n=751). Deferred invasive treatment (balloon angioplasty or coronary bypass surgery) vs. Medical treatment was evaluated on Survival (HR 0.85, 95% CI 0.73-0.99, p=0.034). A deferred invasive treatment strategy significantly improved survival compared to medical treatment in patients with post-thrombolytic Q-wave myocardial infarction (HR 0.85; 95% CI 0.73-0.99; p=0.034).
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