The Survival Advantage of Early Grade 3 Patency After Thrombolysis for Infarction Increases Over Time

The survival advantage for thrombolytic treated infarct patients who exhibit prompt (90′) full coronary patency, grade 3, (versus incomplete, 2, or absent flow, 0, 1) is well established at time points of one week or one month. The GUSTO angiographic study now allows inspection of subsequent changes, if any, in the flow grade specific patency-mortality relationships to one full yearʹs follow up. Of 1173 patients in whom infarct artery (IRA) patency grade was established angiographically 90′ after treatment was begun, 12 month follow up is available in 99.9% (1172). Patency-1 year mortality relationships were: The curves show increasing survival advantage over time consequent to early TIMI grade 3, (compared with all lesser grades) between 30 days (arrow) and 12 months. The one year mortality risk reduction for grade 3 flow is 54% (again vs TIMI grades 0, 1, & 2 combined) p < 0.0001. Notably the total fatality rate from 30 days to one year in the grade 3 group was only 1.4%. Conclusion: The enlarging cumulative survival advantage associated with early establishment of grade 3 flow has been shown (in robust, prospectively followed population) to be progressive at least through one full post MI year.