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

Abstract：

: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.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Kleiman NS,Terrin M,Mueller H,Chaitman B,Roberts R,Knatterud GL,Solomon R,McMahon RP,Braunwald E

doi

10.1016/0735-1097(92)90313-c

subject

Has Abstract

pub_date

1992-05-01 00:00:00

pages

1129-35

issue

6

eissn

0735-1097

issn

1558-3597

pii

0735-1097(92)90313-C

journal_volume

19

pub_type

临床试验,杂志文章,多中心研究,随机对照试验

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