[The long-term efficacy of fibrinolytic treatment in the acute phase of a myocardial infarct. A comparison with a control group]. / Eficacia a largo plazo del tratamiento fibrinolítico en la fase aguda del infarto de miocardio. Comparación con un grupo control.

ABSTRACT

BACKGROUND: The follow-up of patients with an acute myocardial infarction treated with fibrinolysis and that of patients treated with conventional therapy was analyzed. PATIENTS AND METHODS: The study cohort included 1) 214 patients with a first acute infarction of < or = 4 hours and with < or = 70 years of age who participated in a randomized study comparing the effects of streptokinase (SK, n 110) vs conventional treatment (control, n 104), and 2) a total of 361 patients with a myocardial infarction of < or = 6 hours and < or = 75 years old treated with fibrinolytic agents. RESULTS: In-hospital mortality in the randomized study was 11% for the control group and 7% for the SK group, and 8.8% for the rest of patients treated with fibrinolysis. Mortality during follow-up in the randomized study (7.0 +/- 1.5 years) was 10.7% for the SK group and 19.3% for the control group. Ejection fraction was significantly lower in non survivors than in survivors (36.7% vs 50.8%, (p < 0.0001) and among patients with an ejection fraction < 50%, follow-up mortality was significantly lower in those with a complete recanalization (TIMI 3) than in those with an absent or incomplete recanalization (TIMI 0-2) (98% vs 22%). Follow-up mortality for the rest of patients treated with fibrinolysis (2.6 +/- 1.6 years) was 9%. CONCLUSIONS: 1) The reduction of in-hospital mortality by fibrinolysis appears to increase in the long-term follow-up, and 2) the long-term survival seems to be related not only to the left ventricular function but also to the extent of angiographic recanalization.