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European Heart Journal 1999 20(11):819-826; doi:10.1053/euhj.1998.1443
Copyright © 1999 by the European Society of Cardiology.
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Sustained benefit at 10–14 years follow-up after thrombolytic therapy in myocardial infarction

A.C.P. Maasa, R.T. van Domburga,f1, J.W. Deckersa, F. Vermeerb, W.J. Remmec, O. Kampd, V. Manger Catse and M.L. Simoonsa

a Thoraxcenter Cardiology, Erasmus University and University Hospital Rotterdam, Rotterdam, The Netherlands
b University Hospital, Maastricht, The Netherlands
c Zuiderziekenhuis, Rotterdam, The Netherlands
d Free University Hospital, Amsterdam, The Netherlands
e University Hospital, Leiden, The Netherlands

Received December 8, 1998; accepted December 9, 1998

Abstract

Aims To investigate whether the benefit of thrombolytic therapy was sustained beyond the first decade. We report the 10–14 year outcome of 533 patients who were randomized to treatment with intracoronary streptokinase or to conventional therapy during the years 1980–1985.

Methods and Results Details of survival and cardiac events were obtained from the civil registry, from medical records or from the patient’s physician. At follow-up, 158 patients (59%) of the 269 patients allocated to thrombolytic treatment and only 129 patients (49%) of the 264 conventionally treated patients were alive. The cumulative 1-, 5- and 10-year survival rates were 91%, 81% and 69% in patients treated with streptokinase and 84%, 71% and 59% in the control group, respectively (P=0·02). Reinfarction during 10-years of follow-up was more frequent after thrombolytic therapy, particularly during the first year. Coronary bypass surgery and coronary angioplasty were more frequently performed after thrombolytic therapy. At 10 years approximately 30% of the patients were free from subsequent cardiac events.Independent determinants of mortality were elderly age, indicators of impaired residual left ventricular function, multivessel disease and an inability to perform an exercise test at the time of hospital discharge.

Conclusion Improved survival after thrombolytic therapy is maintained beyond the first decade. Age, left ventricular function, multivessel disease and an inability to perform an exercise test were independent predictors for long-term mortality, as they are predictors for early mortality.

Key Words: Myocardial infarction • thrombolysis • follow-up studies • risk factors • survival

f1 Correspondence: R. T. Domburg, PhD, University Hospital Rotterdam Dijkzigt, Thoraxcenter Bd 308, PO Box 2040, 3000 CA Rotterdam, The Netherlands.


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