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European Heart Journal 1996 17(3):382-387;
Copyright © 1996 by the European Society of Cardiology.
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© 1996 The European Society of Cardiology

Mortality, reinfarction, left ventricular ejection fraction and costs following reperfusion therapies for acute mvocardial infarction

F. Zijlstra*,, M. J. de Boer*, W. P. Beukema*, A. L. Liem*, S. Reiffers{dagger}, D. Huysmans{dagger}, J. C. A. Hoorntje*, H. Suryapranata* and M. L. Simoons{ddagger}

*Department of Cardiology, Hospital De Weezenlanden Zwolle, The Netherlands
{dagger}Department of Nuclear Medicine, Hospital De Weezenlanden Zwolle, The Netherlands
{ddagger}Department of Cardiology, Erasmus University Rotterdam, The Netherlands

Received 4 September 1995; accepted 25 October 1995.

Correspondence:Felix Zijistra MD, PhD, Hospital De Weezenlanden, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.

Abstract

The comparative efficacy of thrombolytic drugs and primary angioplasty for acute myocardial infarction have recently been studied, but long-term follow-up data have not yet been reported. We conducted a randomized trial involving 301 patients with acute myocardial infarction; 152 patients were randomized to primary angioplasty and 149 to intravenous streptokinase. Left ventricular function was assessed with a radionuclide technique both at hospital discharge and at the end of the follow-up period. Follow-up data were collected after a mean (± SD) of 31 ± 9 months. Total medical costs were calculated. At the end of the follow-up period, 5% of the angioplasty patients had died from a cardiac cause compared to 11% of the patients randomized to intravenous streptokinase, P=0·031. Cardiac death or a non-fatal reinfarction occurred in 7% of angioplasty patients compared to 28% of streptokinase patients, P0·001. There was a sustained benefit of angioplasty compared to streptokinase on left ventricular function. The total medical costs in the two groups were similar. Coronary anatomy (patency and single or multivessel disease), infarct location and previous myocardial infarction were important determinants of clinical outcome and costs.

After 31±9 months of follow-up, primary angioplasty compared to intravenous streptokinase results in a lower rate of cardiac death and reinfarction, a better left ventricular ejection fraction, and no increase in total medical costs.

(Eur Heart J 1996; 17: 382–387)

Key Words: Acute myocardial infarction • streptokinase • coronary angioplasty


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