P3693Thrombolytic therapy in acute myocardial infarction after previous revascularization; 29-year experience of the POP study

The primary aim of the POP study (PostOperative Prognosis study) is analyze, follow-up and making scores using clinical, angiographic, and procedural variables available 30-day after intervention. The aim of this substudy was to analyze influence of TT after 29 years of follow-up period in pts with AMI after previous CABS who were randomized to either treatment with TT or conventional therapy. Methods: From April 1988 to January 2017 we studied 2618 pts, who developed AMI after CABS, mean age 60.2±3.1 years, mainly men (84.5%). The pts with early perioperative AMI were excluded from the study. The average time interval from CABS to AMI was 92.3±6.0 months. The average number of grafts was 3.1 grafts/pts. All pts were divided in two groups: group I - 953/2618 (36.4%) allocated to TT and group II - 1665/2618 (63.6%) conventionally treated pts. Results: Reinfarction and repeated CABS were more frequently after TT. On 5-year follow-up periods, after 29-year approximately 27% of the pts was free of subsequent cardiac events. The cumulative 1, 5, 10, 15, 20 and 25-year survival rates were 92%, 78%, 68%, 48%, 52% and 44% in pts treated with TT and 83%, 68%, 51%, 43%, 38% and 40% in the control group, respectively (p<0.05). Significant determinants of mortality in multivariate proportional hazards analysis were elderly age, diabetes, previous AMI, indicators of impaired residual left ventricular function and multivessel disease.