The role of intravenous coronary thrombolysis for patients with acute myocardial infarction in different treatment strategies

Abstract

Objective: To examine acute-phase outcomes in acute myocardial infarction (AMI) according to different initial treatments. Patients and methods: This retrospective study involved 405 patients with AMI who had undergone coronary angiography during the acute phase. The patients were retrospectively examined by dividing into groups according to treatment received: intravenous coronary thrombolysis (IVCT) (n=83), intracoronary thrombolysis (ICT) (n=62), and percutaneous coronary intervention (PCI) (n=221). Results: TIMI 3 flow at the initial angiography was higher in the IVCT group (P<0.05) at 32.5% in the IVCT group and 21.7% in the non-IVCT group. The time from onset to initiation of treatment was shorter in the IVCT group (P<0.001) at 227 min in the IVCT group, 337 min in the ICT group, and 479 min in the PCI group. The acute-phase mortality was lower in the IVCT group (P<0.05) at 2.4% in the IVCT group, 3.2% in the ICT group, and 11.8% in the PCI group. According to sub-analysis, the restenosis rate during the chronic phase after PCI did not differ with or without antecedent administration of a thrombolytic agent. Conclusion: IVCT as an initial treatment for AMI enabled the fastest reperfusion at TIMI ≥2 flow, resulting in a good acute-phase outcome. © 2006 The Japanese Society of Internal Medicine.