[Influence of systemic arterial hypertension on mid-term survival of patients with acute myocardial infarction treated with fibrinolytic agents].

BACKGROUND: The purpose of this study to asses the effect of systemic arterial hypertension on mid-term survival of patients with acute myocardial infarction who received thrombolytic treatment. PATIENTS AND METHOD: We studied 202 consecutive patients with acute myocardial infarction, admitted in the Coronary Care Unit of the Hospital Xeral de Galicia who received intravenous thrombolytic therapy within six hours from the onset of symptoms. The thrombolytics used were: urokinase (79.7%), rt-PA (9.9%), streptokinase (4.9%) and APSAC (5.5%). Left heart catheterization with coronary angiography was performed in 162 patients at 2 weeks after infarction. Patency of the infarction-related artery (IRA) was classified according to Thrombolysis in Myocardial Infarction (TIMI) criteria. A patent artery weas defined as having TIMI grades 2 or 3 antegrade flow. RESULTS: Systemic arterial hypertension was found in 34.7% of patients. IRA patency (TIMI 2-3) was demonstrated in the 75.3% of the patients. Early mortality (first month) was 5.4%. Multivariate analysis identified cardiogenic shock as the only variable with independent predictive value for early mortality. Mean follow-up was for 24 +/- 19 months. Late mortality was 5.2% and cardiac death occurred in 4.2% of patients. Reinfarction occurred in 3.1% of patients. Congestive heart failure, arterial hypertension and reinfarction adversely affected prognosis. Actuarial survival at the end of follow-up period was significantly lower in patients with systemic arterial hypertension (70.4% vs 85.9%; p < 0.05). CONCLUSIONS: These data suggest that systemic arterial hypertension adversely affects mid-term prognosis in patients with acute myocardial infarction who received thrombolytic treatment.