Efficacy of coronary angioplasty following conventional coronary thrombolysis in patients with acute myocardial infarction.

The efficacy of combined thrombolysis and angioplasty for the purpose of coronary reperfusion after acute myocardial infarction has been controversial. The present study was conducted, therefore, to evaluate the effects of angioplasty following administration of conventional thrombolytic agents on the long-term prognosis of acute myocardial infarction patients. A total of 409 patients admitted to the hospital within 12 hours of the onset of infarction between January 1990 and May 2001 were studied retrospectively. These included 151 patients treated with thrombolysis alone (group T), 73 patients treated with angioplasty alone (group A), and 35 patients treated with angioplasty after thrombolysis (group T&A). Group T&A had shorter intervals from onset to initial treatment than group A (3.0 hours vs 6.3 hours, p < 0.01), a higher reperfusion success rate than group T (91.4% vs 74.8%, p < 0.01), and more improved left ventricular wall motion than group A. One-year cardiac mortality rates tended to be higher in group T, which had a higher rate of unsuccessful reperfusion than groups T&A or A (8.1% vs 3.4% vs 3.5%). The frequencies of hemorrhagic complications were similar among the 3 groups. From these findings, we conclude that thrombolytic therapy with subsequent angioplasty is an effective strategy for achieving cardiac reperfusion following acute myocardial infarction.

Beta-blockers prevent cardiac events in Japanese patients with myocardial infarction.

BACKGROUND: Although the favorable effects of beta-blockers in the treatment of myocardial infarction (MI) have been repeatedly demonstrated in Western countries, administration of this drug has been limited in Japan. METHODS AND RESULTS: The study group of 1,896 patients with MI was retrospectively divided into 1,029 patients treated by beta-blockers and 867 not treated by beta-blockers, and the incidences of cardiac events, consisting of recurrent MI, death because of worsening heart failure, and sudden death, and cardiovascular events, comprising cardiac events and stroke, were compared in both groups. There were 45 cardiac events (4.4%, 30.1 patients/1,000 patients. year) among the beta-blocker group, which was significantly less than the 56 cardiac events (6.5%, 52.3 patients/1,000 patients. year) among the no-beta-blocker group (p<0.05). The total mortality was 92 (8.9%, 61.6 patients/1,000 patients. year) and 124 (14.3%, 115.8 patients/1,000 patients. year), respectively, and cardiac death occurred in 42 (4.1%, 28.1 patients/1,000 patients. year) and 53 (6.1%, 49.5 patients/1,000 patients. year), respectively, indicating that both these events occurred significantly less in the beta-blocker group (p<0.01 and p<0.05). CONCLUSIONS: Beta-blockers prevent cardiac events in Japanese patients with MI. However, a placebo-controlled, double-blind, multicenter, clinical trial conducted on a large scale in Japan would further contribute more precise information of the useful effects of beta-blockers.