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ARTICLE |

Thrombolytic Therapy of Patients With Acute Myocardial Infarction FREE

Robert C. Schlant, MD
[+] Author Affiliations

Reprint requests to Department of Medicine (Cardiology), Emory University School of Medicine, 69 Butler St SE, Atlanta, GA 30303 (Dr Schlant).


JAMA. 1990;264(6):738-739. doi:10.1001/jama.1990.03450060084035
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In this issue of The Journal, Naylor and Jaglal1 report the results of their meta-analysis of patients with acute myocardial infarction who were enrolled in seven randomized control trials of thrombolytic therapy with either tissue plasminogen activator or streptokinase between March 1982 and November 1987. The authors did a meta-analysis of the number of procedures (cardiac catheterization, coronary angioplasty, or surgical coronary revascularization) performed within 6 weeks of myocardial infarction in the patients in each study treated either with or without thrombolytic therapy. Overall, in the seven trials there was a relative increase of 80% in the number of revascularization procedures (angioplasty or bypass surgery) performed on the patients treated with thrombolytic therapy; the relative increase in the number of procedures was higher in patients treated with tissue plasminogen activator than in patients treated with streptokinase. A similar increase in coronary revascularization procedures after thrombolytic therapy for myocardial infarction

REFERENCES

Naylor CD, Jaglal SB.  Impact of intravenous thrombolysis on short-term coronary revascularization rates: a meta-analysis . JAMA . 1990;;264:697-702.
Floras JS, Naylor CD, Armstrong PW.  Coronary revascularization after thrombolytic therapy for myocardial infarction: what caseloads could Canadian centres face? Can Med Assoc J. 1989;;141:783-790.
Steinberg EP, Topol EJ, Sakin JW, et al.  Cost and procedure implications of thrombolytic therapy for acute myocardial infarction . J Am Coll Cardiol. 1988;;12:58A-68A.
Falk E.  Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis: characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi. Br Heart J. 1983;;50:127-134.
Davies MJ, Thomas AC.  Plaque fissuring: the cause of acute myocardial infarction, sudden ischemic death, and crescendo angina . Br Heart J. 1985;;53:363-373.
Hackett D, Davies G, Maseri A.  Pre-existing coronary stenoses in patients with first myocardial infarction are not necessarily severe . Eur Heart J. 1988;;9:1317-1323.
Davies JD, Thomas A.  Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death . N Engl J Med. 1984;;310:1137-1140.
Falk E.  Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death: autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion . Circulation. 1985;;71:699-708.
Davies MJ, Thomas AC, Knapman PA, Hangartner JR.  Intramyocardial platelet aggregation in patients with unstable angina suffering sudden ischemic cardiac death . Circulation . 1986;;73:418-427.
Grines CL, DeMaria AN.  Optimal utilization of thrombolytic therapy for acute myocardial infarction: concepts and controversies . J Am Coll Cardiol. 1990;;16:223-231.
Lavie CJ, Gersh BJ.  Acute myocardial infarction: initial manifestations, management, and prognosis . Mayo Clin Proc. 1990;;65:531-548.
Lavie CJ, Gersh HJ, Chesebro JH.  Reperfusion in acute myocardial infarction . Mayo Clin Proc. 1990;;65:549-564.
Simoons MS, Arnold AER, Betriu A, et al.  Thrombolysis with tissue plasminogen activator in acute myocardial infarction: no additional benefit from immediate percutaneous coronary angioplasty . Lancet . 1988;;1:197-202.
TIMI Study Group.  Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI) Phase II trial . N Engl J Med. 1989;;320:618-627.

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Naylor CD, Jaglal SB.  Impact of intravenous thrombolysis on short-term coronary revascularization rates: a meta-analysis . JAMA . 1990;;264:697-702.
Floras JS, Naylor CD, Armstrong PW.  Coronary revascularization after thrombolytic therapy for myocardial infarction: what caseloads could Canadian centres face? Can Med Assoc J. 1989;;141:783-790.
Steinberg EP, Topol EJ, Sakin JW, et al.  Cost and procedure implications of thrombolytic therapy for acute myocardial infarction . J Am Coll Cardiol. 1988;;12:58A-68A.
Falk E.  Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis: characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi. Br Heart J. 1983;;50:127-134.
Davies MJ, Thomas AC.  Plaque fissuring: the cause of acute myocardial infarction, sudden ischemic death, and crescendo angina . Br Heart J. 1985;;53:363-373.
Hackett D, Davies G, Maseri A.  Pre-existing coronary stenoses in patients with first myocardial infarction are not necessarily severe . Eur Heart J. 1988;;9:1317-1323.
Davies JD, Thomas A.  Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death . N Engl J Med. 1984;;310:1137-1140.
Falk E.  Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death: autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion . Circulation. 1985;;71:699-708.
Davies MJ, Thomas AC, Knapman PA, Hangartner JR.  Intramyocardial platelet aggregation in patients with unstable angina suffering sudden ischemic cardiac death . Circulation . 1986;;73:418-427.
Grines CL, DeMaria AN.  Optimal utilization of thrombolytic therapy for acute myocardial infarction: concepts and controversies . J Am Coll Cardiol. 1990;;16:223-231.
Lavie CJ, Gersh BJ.  Acute myocardial infarction: initial manifestations, management, and prognosis . Mayo Clin Proc. 1990;;65:531-548.
Lavie CJ, Gersh HJ, Chesebro JH.  Reperfusion in acute myocardial infarction . Mayo Clin Proc. 1990;;65:549-564.
Simoons MS, Arnold AER, Betriu A, et al.  Thrombolysis with tissue plasminogen activator in acute myocardial infarction: no additional benefit from immediate percutaneous coronary angioplasty . Lancet . 1988;;1:197-202.
TIMI Study Group.  Comparison of invasive and conservative strategies after treatment with intravenous tissue plasminogen activator in acute myocardial infarction: results of the Thrombolysis in Myocardial Infarction (TIMI) Phase II trial . N Engl J Med. 1989;;320:618-627.
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