One-year results of the Thrombolysis in Myocardial Infarction Investigation (TIMI) Phase II Trial

David O. Williams, Eugene Braunwald, Genell Knatterud, Joseph Babb, John Bresnahan, Mark A. Greenberg, Albert Raizner, Alan Wasserman, Thomas Robertson, Richard Ross

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

Background. The Thrombolysis in Myocardial Infarction (TIMI) Phase II Trial randomized 3,339 patients to either an invasive (INV, n=1,681) or a conservative (CON, n=1,658) strategy after intravenous recombinant tissue-type plasminogen activator (rt-PA) for acute myocardial infarction. Methods and Results. The patients assigned to the INV strategy routinely underwent cardiac catheterization, and when anatomically appropriate, percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting 18-48 hours after infarction. CON patients had these procedures only in response to the occurrence of spontaneous or provoked ischemia. One-year follow-up data are available in 3,316 patients (99.3%). The primary trial end point, death and nonfatal reinfarction, occurred in 14.7% of INV patients and in 15.2% of CON patients (p=NS. When analyzed individually, there was no difference (p=NS) in death (INV, 6.9%; CON, 7.4%) or recurrent infarction (INV, 9.4%; CON, 9.8%) between the two groups. Anginal status at 1 year was also similar. Cardiac catheterization and PTCA were performed more often in INV (98.0% and 61.2%, respectively) compared with CON (45.2% and 20.5%, respectively) patients. At 1 year, the cumulative number of patients who underwent coronary bypass surgery (INV, 17.5%; CON, 173%) was similar in the two groups. Conclusions. The INV and CON strategies resulted in similar favorable outcomes at 1 year of follow-up. In particular, the rates of mortality and reinfarction were not different and were impressively low in both groups. One possible advantage of the INV strategy was detected in subgroup analyses. In patients with a history of myocardial infarction, the data are suggestive that 1-year mortality was lower in INV patients (10.3%) than in CON patients (17.0%) (p=0.03).

Original languageEnglish (US)
Pages (from-to)533-542
Number of pages10
JournalCirculation
Volume85
Issue number2
StatePublished - Feb 1992
Externally publishedYes

Fingerprint

Myocardial Infarction
Coronary Balloon Angioplasty
Cardiac Catheterization
Infarction
Mortality
Tissue Plasminogen Activator
Coronary Artery Bypass
Ischemia

Keywords

  • Acute myocardial infarction
  • Cardiac catheterization
  • Coronary angioplasty
  • Coronary artery disease
  • rt-PA
  • Thrombolysis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Williams, D. O., Braunwald, E., Knatterud, G., Babb, J., Bresnahan, J., Greenberg, M. A., ... Ross, R. (1992). One-year results of the Thrombolysis in Myocardial Infarction Investigation (TIMI) Phase II Trial. Circulation, 85(2), 533-542.

One-year results of the Thrombolysis in Myocardial Infarction Investigation (TIMI) Phase II Trial. / Williams, David O.; Braunwald, Eugene; Knatterud, Genell; Babb, Joseph; Bresnahan, John; Greenberg, Mark A.; Raizner, Albert; Wasserman, Alan; Robertson, Thomas; Ross, Richard.

In: Circulation, Vol. 85, No. 2, 02.1992, p. 533-542.

Research output: Contribution to journalArticle

Williams, DO, Braunwald, E, Knatterud, G, Babb, J, Bresnahan, J, Greenberg, MA, Raizner, A, Wasserman, A, Robertson, T & Ross, R 1992, 'One-year results of the Thrombolysis in Myocardial Infarction Investigation (TIMI) Phase II Trial', Circulation, vol. 85, no. 2, pp. 533-542.
Williams DO, Braunwald E, Knatterud G, Babb J, Bresnahan J, Greenberg MA et al. One-year results of the Thrombolysis in Myocardial Infarction Investigation (TIMI) Phase II Trial. Circulation. 1992 Feb;85(2):533-542.
Williams, David O. ; Braunwald, Eugene ; Knatterud, Genell ; Babb, Joseph ; Bresnahan, John ; Greenberg, Mark A. ; Raizner, Albert ; Wasserman, Alan ; Robertson, Thomas ; Ross, Richard. / One-year results of the Thrombolysis in Myocardial Infarction Investigation (TIMI) Phase II Trial. In: Circulation. 1992 ; Vol. 85, No. 2. pp. 533-542.
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abstract = "Background. The Thrombolysis in Myocardial Infarction (TIMI) Phase II Trial randomized 3,339 patients to either an invasive (INV, n=1,681) or a conservative (CON, n=1,658) strategy after intravenous recombinant tissue-type plasminogen activator (rt-PA) for acute myocardial infarction. Methods and Results. The patients assigned to the INV strategy routinely underwent cardiac catheterization, and when anatomically appropriate, percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting 18-48 hours after infarction. CON patients had these procedures only in response to the occurrence of spontaneous or provoked ischemia. One-year follow-up data are available in 3,316 patients (99.3{\%}). The primary trial end point, death and nonfatal reinfarction, occurred in 14.7{\%} of INV patients and in 15.2{\%} of CON patients (p=NS. When analyzed individually, there was no difference (p=NS) in death (INV, 6.9{\%}; CON, 7.4{\%}) or recurrent infarction (INV, 9.4{\%}; CON, 9.8{\%}) between the two groups. Anginal status at 1 year was also similar. Cardiac catheterization and PTCA were performed more often in INV (98.0{\%} and 61.2{\%}, respectively) compared with CON (45.2{\%} and 20.5{\%}, respectively) patients. At 1 year, the cumulative number of patients who underwent coronary bypass surgery (INV, 17.5{\%}; CON, 173{\%}) was similar in the two groups. Conclusions. The INV and CON strategies resulted in similar favorable outcomes at 1 year of follow-up. In particular, the rates of mortality and reinfarction were not different and were impressively low in both groups. One possible advantage of the INV strategy was detected in subgroup analyses. In patients with a history of myocardial infarction, the data are suggestive that 1-year mortality was lower in INV patients (10.3{\%}) than in CON patients (17.0{\%}) (p=0.03).",
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T1 - One-year results of the Thrombolysis in Myocardial Infarction Investigation (TIMI) Phase II Trial

AU - Williams, David O.

AU - Braunwald, Eugene

AU - Knatterud, Genell

AU - Babb, Joseph

AU - Bresnahan, John

AU - Greenberg, Mark A.

AU - Raizner, Albert

AU - Wasserman, Alan

AU - Robertson, Thomas

AU - Ross, Richard

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N2 - Background. The Thrombolysis in Myocardial Infarction (TIMI) Phase II Trial randomized 3,339 patients to either an invasive (INV, n=1,681) or a conservative (CON, n=1,658) strategy after intravenous recombinant tissue-type plasminogen activator (rt-PA) for acute myocardial infarction. Methods and Results. The patients assigned to the INV strategy routinely underwent cardiac catheterization, and when anatomically appropriate, percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting 18-48 hours after infarction. CON patients had these procedures only in response to the occurrence of spontaneous or provoked ischemia. One-year follow-up data are available in 3,316 patients (99.3%). The primary trial end point, death and nonfatal reinfarction, occurred in 14.7% of INV patients and in 15.2% of CON patients (p=NS. When analyzed individually, there was no difference (p=NS) in death (INV, 6.9%; CON, 7.4%) or recurrent infarction (INV, 9.4%; CON, 9.8%) between the two groups. Anginal status at 1 year was also similar. Cardiac catheterization and PTCA were performed more often in INV (98.0% and 61.2%, respectively) compared with CON (45.2% and 20.5%, respectively) patients. At 1 year, the cumulative number of patients who underwent coronary bypass surgery (INV, 17.5%; CON, 173%) was similar in the two groups. Conclusions. The INV and CON strategies resulted in similar favorable outcomes at 1 year of follow-up. In particular, the rates of mortality and reinfarction were not different and were impressively low in both groups. One possible advantage of the INV strategy was detected in subgroup analyses. In patients with a history of myocardial infarction, the data are suggestive that 1-year mortality was lower in INV patients (10.3%) than in CON patients (17.0%) (p=0.03).

AB - Background. The Thrombolysis in Myocardial Infarction (TIMI) Phase II Trial randomized 3,339 patients to either an invasive (INV, n=1,681) or a conservative (CON, n=1,658) strategy after intravenous recombinant tissue-type plasminogen activator (rt-PA) for acute myocardial infarction. Methods and Results. The patients assigned to the INV strategy routinely underwent cardiac catheterization, and when anatomically appropriate, percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting 18-48 hours after infarction. CON patients had these procedures only in response to the occurrence of spontaneous or provoked ischemia. One-year follow-up data are available in 3,316 patients (99.3%). The primary trial end point, death and nonfatal reinfarction, occurred in 14.7% of INV patients and in 15.2% of CON patients (p=NS. When analyzed individually, there was no difference (p=NS) in death (INV, 6.9%; CON, 7.4%) or recurrent infarction (INV, 9.4%; CON, 9.8%) between the two groups. Anginal status at 1 year was also similar. Cardiac catheterization and PTCA were performed more often in INV (98.0% and 61.2%, respectively) compared with CON (45.2% and 20.5%, respectively) patients. At 1 year, the cumulative number of patients who underwent coronary bypass surgery (INV, 17.5%; CON, 173%) was similar in the two groups. Conclusions. The INV and CON strategies resulted in similar favorable outcomes at 1 year of follow-up. In particular, the rates of mortality and reinfarction were not different and were impressively low in both groups. One possible advantage of the INV strategy was detected in subgroup analyses. In patients with a history of myocardial infarction, the data are suggestive that 1-year mortality was lower in INV patients (10.3%) than in CON patients (17.0%) (p=0.03).

KW - Acute myocardial infarction

KW - Cardiac catheterization

KW - Coronary angioplasty

KW - Coronary artery disease

KW - rt-PA

KW - Thrombolysis

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