Association of lesion complexity following fibrinolytic administration with mortality in ST-elevation myocardial infarction

Greater lesion complexity, according to the American College of Cardiology and American Heart Association, has been associated with decreased success rates of percutaneous coronary intervention. We hypothesized that greater lesion complexity after fibrinolytic administration for ST-segment elevation...

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Bibliographic Details
Published in:The American journal of cardiology 2004-07, Vol.94 (1), p.108-111
Main Authors: Gibson, C.Michael, Bigelow, Brian, James, David, Tepper, Micah R, Murphy, Sabina A, Kirtane, Ajay J, Giugliano, Robert P, Cannon, Christopher P, Antman, Elliott M
Format: Article
Language:English
Subjects:
Angioplasty, Balloon, Coronary
Biological and medical sciences
Cardiology. Vascular system
Clinical Trials as Topic
Coronary Angiography
Coronary heart disease
Drug therapy
Female
Heart
Heart attacks
Humans
Male
Medical sciences
Middle Aged
Mortality
Myocardial Infarction - diagnostic imaging
Myocardial Infarction - drug therapy
Myocardial Infarction - mortality
Myocardial Infarction - pathology
Myocardial Infarction - therapy
Myocarditis. Cardiomyopathies
Severity of Illness Index
Thrombolytic Therapy
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Summary:Greater lesion complexity, according to the American College of Cardiology and American Heart Association, has been associated with decreased success rates of percutaneous coronary intervention. We hypothesized that greater lesion complexity after fibrinolytic administration for ST-segment elevation myocardial infarction would similarly be associated with increased mortality and other adverse events at 30 days. We studies 2,605 patients from the Thrombolysis In Myocardial Infarction 10B and 14, Integrilin and Tenecteplase in Acute Myocardial Infarction, ENTIRE, and FASTER studies. For all studies, angiographic outcomes were assessed immediately after fibrinolytic administration and clinical outcomes were assessed at 30 days. Greater lesion complexity was associated with poorer epicardial flow and decreased myocardial perfusion at 60 minutes and after percutaneous coronary intervention and with a higher risk of shock and mortality within 30 days. In a multivariate model, type C lesion complexity remained associated with an increased 30-day mortality rate.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2004.03.038