Effect of Fibrinolytic Therapy in Reperfusion of the Coronary Artery on the Prognosis in Acute Myocardial Infarction

ABSTRACT

PURPOSE: The most significant advance in treatment of acute myocardial infarction is reperfusion therapy with fibrinolytics and percutaneous coronary intervention (PCI). The aim of this study was to assess the efficacy of reperfusion and the clinical outcomes of patients with acute myocardial infarction (AMI) who underwent fibrinolytic therapy. METHODS: A retrospective chart review was done for 226 patients with acute myocardial infarction who met the criteria for fibrinolytic therapy. We compared the thrombolysisin-myocardia-infarction (TIMI) flow in angiography of the infarct-related artery and the clinical outcomes between patients with and without fibrinolytic therapy. Also we analyzed the effects of fibrinolytics in various treatment modalities. The clinical outcomes included the 30-day mortality, repeat AMI/unstable angina, and coronary artery bypass graft (CABG). RESULTS: Angiography after fibrinolytic therapy revealed TIMI grades 0/1, 2, or 3 flow in 15.1%, 21.4%, and 63.5% of vessels, respectively, but in patients without fibrinolytic therapy those percent were 35.0%, 26.0%, and 39.0%, respectively. A significantly increased mortality was seen in patients with lower TIMI grade flow (11.1%, 0%, and 0.8% with TIMI grade 0/1, 2 and 3, respectively, p =0.001). The 30-day mortality were significantly lower in patients with fibrinolytic therapy than in patients without fibrinolytic therapy, particularly in patients with TIMI grade 0-2 flow. There was no significant difference in the 30-day mortality and the clinical outcomes among patients with fibrinolytic therapy, emergency PCI, and delayed PCI. CONCLUSION: Fibrinolytic therapy improved the TIMI flow in angiography and reduced the 30-day mortality.