Author + information
- Received October 15, 2002
- Revision received December 5, 2002
- Accepted December 18, 2002
- Published online July 2, 2003.
- C.Michael Gibson, MS, MD*,* (, )
- Juhana Karha, MD*,
- Sabina A Murphy, MPH*,
- David James, BS*,
- David A Morrow, MPH, MD*,
- Christopher P Cannon, MD*,
- Robert P Giugliano, SM, MD*,
- Elliott M Antman, MD*,
- Eugene Braunwald, MD*,
- TIMI Study Group
- ↵*Reprint requests and correspondence:
Dr. C. Michael Gibson, TIMI Study Group, 350 Longwood Avenue, 1st Floor, Boston, Massachusetts 02115, USA.
Objectives We hypothesized that early recurrent myocardial infarction (MI) following fibrinolytic administration would be assessed with higher mortality at both 30 days and 2 years.
Background Although early recurrent MI after fibrinolytic therapy has been associated with increased early mortality in the acute MI setting, its relation to long-term mortality has not been fully explored.
Methods Mortality data were ascertained in 20,101 patients enrolled in the Thrombolysis In Myocardial Infarction (TIMI) 4, 9, and 10B and Intravenous NPA for the Treatment of Infarcting Myocardium Early (InTIME-II) acute MI trials.
Results The frequency of symptomatic recurrent MI during the index hospitalization was 4.2% (836/20,101). Recurrent MI during the index hospital period was associated with increased 30-day mortality (16.4% [137/836] vs. 6.2% [1,188/19,260], p < 0.001). Likewise, recurrent MI was associated with a sustained increase in mortality up to two years, even after adjustments were made for covariates known to be associated with mortality and recurrent MI (hazard ratio 2.11, p < 0.001). However, this higher mortality at 2 years was due to an early divergence in mortality by 30 days and was not due to a significant increase in late mortality between 30 days and 2 years (4.38% [31/707] vs. 3.76% [685/18,206], p = NS). Percutaneous coronary intervention during the index hospitalization was associated with a lower rate of in-hospital recurrent MI (1.6% vs. 4.5%, p < 0.001) and lower two-year mortality (5.6% vs. 11.6%, p < 0.001). Performance of coronary artery bypass graft surgery was also associated with a lower recurrent rate of MI (0.7% vs. 4.3%, p < 0.001) and lower two-year mortality rate (7.95% vs. 10.6%, p = 0.0008).
Conclusions Early recurrent MI is associated with increased mortality up to two years. However, most deaths occur early, and the risk of additional deaths between the index hospital period and two years was not significantly increased among patients with recurrent MI. Percutaneous coronary intervention during the index hospitalization was associated with a lower risk of recurrent MI and a lower risk of two-year mortality.
☆ This study was supported in part by a grant from Smith Kline Beecham, Philadelphia, Pennsylvania (TIMI 4); Ciba-Geigy Corp., Summit, New Jersey (TIMI 9A and 9B); Genentech, Inc., South San Francisco, California, and Boehringer-Ingelheim, Rheimberg, Germany (TIMI 10B); and Bristol-Myers Squibb, New York, New York (InTIME-II).
- Received October 15, 2002.
- Revision received December 5, 2002.
- Accepted December 18, 2002.
- American College of Cardiology Foundation