Coronary angioplasty performed within the thrombolysis in myocardial infarction II study

Donald S. Baim, Daniel J. Diver, Frederick Feit, Mark A. Greenberg, David R. Holmes, Bonnie H. Weiner, David O. Williams, Marc J. Schweiger, B. Greg Brown, Margaret M. Frederick, Genell L. Knatterud, Eugene Braunwald

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Background. Percutaneous transluminal coronary angioplasty (PTCA) of the infarct-related artery was performed within 42 days of recombinant tissue-type plasminogen activator (rt-PA) administration in 1,414 of the 3,534 patients who participated in the Thrombolysis In Myocardial Infarction (TIMI) II study. Primary angiographic success was obtained in 88.7%, with bypass surgery within 24 hours in 3.3% and death within 24 hours in 0.7% of patients. By 1 year, 25.1% of the 1,414 patients had sustained one or more adverse outcomes including death (3.6%), reinfarction (8.4%), or the need for further revascularization (20%). Methods and Results. Despite these generally favorable results, multivariate testing identified several anatomic and clinical subgroups as having an increased risk ratio (RR) for adverse outcome: Unsuccessful PTCA was more common in patients undergoing protocol-assigned PTCA within 2 hours of rt-PA administration (RR, 2.7;p<0.001) and in patients over age 70 years (RR, 1.7; p=0.034). The need for further revascularization within 1 year was increased in the 30.4% of patients with multivessel disease (RR, 2.5;p<0.001), patients with prior angina (RR, 1.4;p=0.006), or those undergoing ischemia-driven PTCA within 15 hours of rt-PA administration (RR, 1.7; p=0.022). The risk of death or recurrent infarction within 1 year was increased by the presence of multivessel disease (RR, 1.6; p=0.007) or prior angina (RR, 1.5; p=0.014). Conclusions. These observations do not necessarily apply to patients undergoing primary PTCA (or PTCA after other thrombolytic agents); however, they do offer a unique yardstick against which to evaluate the results of PTCA in myocardial infarction.

Original languageEnglish (US)
Pages (from-to)93-105
Number of pages13
JournalCirculation
Volume85
Issue number1
DOIs
StatePublished - Jan 1992
Externally publishedYes

Keywords

  • Clinical trials
  • Percutaneous transluminal coronary angioplasty
  • TIMI-II Study
  • rt-PA

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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