Reduction of congestive heart failure symptoms by very early fibrinolytic therapy in acute myocardial infarction: A long-term follow-up

Background: In patients with acute myocardial infarction (MI), early fibrinolytic therapy results in improved survival and preservation of ventricular function. The purpose of the study was to determine whether very early treatment also reduces the development of congestive heart failure. Methods and Results: During the years 1984 to 1989, 358 consecutive patients with acute MI were treated with streptokinase, 161 within the first 1.5 hours from the onset of chest pain (group A) and 197 within 1.5 to 4.0 hours (group B). In 68, fibrinolysis was initiated in the prehospital setting pioneered by our group. Symptoms related to heart failure including dyspnea on exertion, fatigue, orthopnea, paroxysmal nocturnal dyspnea, nocturia, and peripheral edema, in addition to pulmonary edema events, were assessed during 5 years of follow-up. The evaluation was based on medical records and a detailed questionnaire, which was filled in by the investigators. A favorable significant effect of very early thrombolysis on the development of most of these limiting symptoms appeared 3 months after hospital discharge and persisted thereafter (P < .05). During hospitalization, pulmonary edema attacks occurred less frequently in patients from group A (23% vs 36.5%, P < .01). This difference persisted during 4 years of follow-up (13% vs 36%, P < .001). Conclusions: Our data demonstrate that very early fibrinolytic therapy results in a significant long-term reduction of congestive heart failure- related symptoms and thereby improves the quality of life in patients after MI.