Adverse long-term effects of reocclusion after coronary thrombolysis

Objectives. This study sought to assess the long-term clinical consequences of reocclusion after coronary thrombolysis. Background. After acute myocardial infarction successfully treated with thrombolysis, reocclusion occurs in not, vert, similar 30% of patients and leads to poorer in-hospital outcome. However, the long-term effects of reocclusion are unknown. Methods. Three hundred patients with no history of coronary surgery and with patent infarct-related artery at coronary angiography within 48 h after thrombolysis were enrolled in the Antithrombotics in the Prevention of Reocclusion in Coronary Thrombolysis (APRICOT) trial. At mean (±SD) of 77 ± 23 days after thrombolysis, 248 patients (87%) underwent follow-up angiography. Reocclusion was observed in 71 (29%) of 248 patients. To compare outcome between 71 patients with and 177 without reocclusion an analysis of event-free survival, defined as clinical course without death, reinfarction and revascularization, was performed. Results. Over 3-year follow-up period, event-free survival was significantly better in patients without reocclusion: At 1 year it was 63% for patients with and 83% for those without reocclusion (p < 0.001). In the first year, two or more cardiac-related events occurred in 24% of patients with and 6% of those without reocclusion (p < 0.001). Patients with reocclusion had markedly higher reinfarction and revascularization rate. At 1 year the reinfarction rate was 23% for patients with and 5% for those without reocclusion (p < 0.001). Conclusions. This analysis shows the adverse influence of reocclusion on long-term clinical outcome in relation to reinfarction and need for revascularization. To further optimize prognosis after thrombolysis, prevention of reocclusion should become main priority. Future research should focus on the criteri and timing of elective revascularization procedures in the prevention of coronary reocclusion.