engleski

Antecedent angina pectoris and the short-term outcome after thrombolytic therapy for acute myocardial infarction

Results of previous studies have noted an association between antecedent angina pectoris (AP) and effects of thrombolytic therapy for acute myocardial infarction (AMI). Nevertheless, the reported results are not unanimous. A total of 383 consecutive patients with AMI eligible for thromblytic treatment were included in the study. One hundred seventy-seven (46%) patients gave history of chronic AP (>1 month) before AMI. Patients with AP had higher incidents of previous myocardial infarction (27% vs 4%, p<0.001) and recurrent ischemia (19% vs 7%, p< 0.001) ; the incidence of non– Q was also higher, but with borderline statistical significance (14% vs 8%, p=0.05). Successful reperfusion was achieved in 66% patients with antecedent AP, and in 69% patients without AP (p=0.66), and the reocclusion rate was the same in both groups (7%). Multivariate analysis confirmed the independent association of antecedent AP with previous infarction (p<0.001), recurrent ischemia (p<0.001) and the incidence of non– Q AMI (p=0.034). All patients were further divided in to 3 groups regarding the effects of thrombolytic therapy: successful reperfusion (group 1), no reperfusion (group 2), reperfusion followed by reocclusion (group 3), and subdivided with respect to the presence or absence of antecendent AP (groups 1a, 2a, 3a, and 1b, 2b, 3b, respectively.). The incidence of previous infarction was higher in all groups with antecendent AP (groups 1a, 2a, 3a). The incidence of recurrent ischemia was higher in groups 1a and 2a compared to 1b and 2b, respectively. In the group of patients with reocclusion the rate of recurrent ischemia was very high, but with no difference regarde to antecendent AP. Furthermore patients in groups in 1a, and 2a more frequently presented with a non-Q AMI than patients in gropus 1b and 2b. The in- hospital course of patients without reperfusion or with reocclusion was more complicated, with higher incidence of left ventricular dysfunction, rhythm disturbances and higher mortality rate, but there were no differences regarding the presence or apsence of preciding AP. It is concluded that antecendent AP is an independent predictor neither of the success of thrombolytic therapy nor the incidence of major complications in patients receiving thrombolysis for AMI.

Thrombolysis; acute infarction; prognosis

nije evidentirano