Extended Mortality Benefit of Early Postinfarction Reperfusion

摘要: Background —Reperfusion therapy for myocardial infarction, understood to reduce mortality by preserving left ventricular function, was initially expected provide increasing benefits over time. Surprisingly, large controlled thrombolysis trials demonstrated maximum benefit at 4 6 weeks with no subsequent increased treatment advantage. Such studies, however, compared groups assigned treatment, not physiological effectiveness. Methods and Results —We calculated 2-year survival differences among 2431 infarction patients according early infarct artery patency outcome ejection fraction using Kaplan-Meier curves. Hazard ratios significant determinants were derived from Cox regression models. Two-year vital status (minimum, 688 days) determined in 2375 (97.7%). A substantial advantage complete reperfusion (Thrombolysis Myocardial Infarction [TIMI] grade 3) preserved occurred beyond 30 days. The unadjusted hazard ratio the TIMI 3 group lesser grades days 0.57 (95% confidence interval [CI], 0.35 0.94) ≥688 0.39 CI, 0.22 0.69). Consequently, flow associated approximately a patient per 100 reduction first month an additional 5 lives 2 years. For >40% ≤40%, 0.25 0.16 0.37) 0.15 0.33) after through years (lives saved, ≈9 11 100, respectively). Conclusions —Successful salvage produce that are amplified initial