Mechanisms of early death despite thrombolytic therapy: Experience from the Thrombolysis in Myocardial Infarction Phase II (TIMI II) study

Mechanisms of early death despite thrombolytic therapy: Experience from the Thrombolysis in Myocardial Infarction Phase II (TIMI II) study

Mechanisms of death among patients who died within 18 h of enrollment in the Thrombolysis in Myocardial Infarction Phase II (TIMI II) study were analyzed. Of 3,339 patients enrolled, 32 died within the 1st 4 h and 31 died within the subsequent 14 h. Thirteen of the 63 patients had shock at enrollmen...

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Bibliographic Details
Published in:Journal of the American College of Cardiology Vol. 19; no. 6; pp. 1129 - 1135
Main Authors: Kielman, Neal S, Terrin, Michael, Mueller, Hiltrud, Chaitman, Bernard, Roberts, Robert, Knatterud, Genell L, Solomon, Rachel, McMahon, Robert P, Braunwald, Eugene
Format: Journal Article
Language:English
Published: New York, NY Elsevier Inc 01-05-1992
Elsevier Science
Subjects:
Adrenergic beta-Antagonists - administration & dosage
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Cause of Death
Chi-Square Distribution
Drug Evaluation
Humans
Infusions, Intravenous
Medical sciences
Myocardial Infarction - drug therapy
Myocardial Infarction - mortality
Pharmacology. Drug treatments
Prognosis
Recombinant Proteins - administration & dosage
Survival Rate
Thrombolytic Therapy
Time Factors
Tissue Plasminogen Activator - administration & dosage
United States
United States
Human
Chemotherapy
Treatment
Infarct
Pathogenesis
Myocardium
Cardiovascular disease
Death
Coronary heart disease
Fibrinolytic
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Summary:Mechanisms of death among patients who died within 18 h of enrollment in the Thrombolysis in Myocardial Infarction Phase II (TIMI II) study were analyzed. Of 3,339 patients enrolled, 32 died within the 1st 4 h and 31 died within the subsequent 14 h. Thirteen of the 63 patients had shock at enrollment; 22 had advanced hemodynamic compromise without shock and 28 initially had minimal to no compromise. Prior infarction was present in 16 patients (25%). Pump failure was responsible for 39 early deaths (62%), ventricular rupture for 10 (16%), arrhythmia for 8 (13%) and complications of therapy for 6 (10%). Nine of 720 patients randomized to immediate intravenous beta-adrenergic blocking agent therapy had an early death compared with 6 of 714 assigned to deferred beta-blocker therapy. Thus, mortality is highest in the early hours after myocardial infarction, even in patients treated with thrombolytic therapy and is most frequently due to pump failure. These results imply that efforts to reduce mortality during this critical time period should be directed at prevention, limitation or palliation of early pump failure.
Bibliography:ObjectType-Article-2
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ISSN:0735-1097
1558-3597
DOI:10.1016/0735-1097(92)90313-C