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Thrombolysis efficacy overestimated inacuteMI
THERAPY
Thrombolytic treatment in acute MI requires improvement to reduce the incidence of primary and secondary treatment failure. So say researchers from Germany who conducted a retrospective analysis of data from patients included in 4 co-operative angiographic studies who had received thrombolytic treatment for acute MI. In these 4 studies. the primary endpoint was angiographic patency of the infarct-related artery 90 minutes after thrombolysis had been initiated.
9O-minute patency rate misleading Of the 907 patients who had received thrombolytic
therapy and had an angiogram 90 minutes after receiving treatment. 75'7c of patients had an open infarct vessel fulfilling TIMI grade 2 or 3 criteria. and 629t of patients had complete reperfusion. fulfilling TIMI grade 3 criteria i.e. primary treatment success. However, thereafter, primary and secondary failure (which included reinfarction. reocc1usion and death) occurred in 38 and l29t of patients. respectively.
The researchers comment that their data indicate that thrombolysis efficacy in acute MI is substantially overestimated by 90-minute patency rates. Although patency was evident in 759t of patients at 90 minutes, only approximately 50Ck of patients actually achieved the optimal result of thrombolysis. VOgI A. von Es,""n R. Tebbe t:. Feuerer W. Appel KF. ct al. Frequency of
achieving optimal repcrfusion with thrombolysis in acute mY'ocardial infarction (analysis of four Gennan multicenter studies). Amcncan Journal of Cardiology 74: 1-4. 1 Jul 1994
0156.2703194/0947.00015/$0100° Adislnternational Limited 1994. All rights reserved
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INPHARMA~ 23 Ju11994