Eligibility of patients with acute myocardial infarction for thrombolytic therapy: retrospective cohort study
L Zaputović1, Z Mavrić, B Mlinarić
1Department of Internal Medicine, University Hospital Center Rijeka, Kresimirova 42, 51000 Rijeka, Croatia. luka.zaputovic@mamed.medri.hr
Insights
Thrombolytic therapy (TT) for acute myocardial infarction (AMI) was underutilized, particularly in older women with prior heart attacks. Improving treatment eligibility and reducing delays can lower mortality.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Research
Background:
- Acute myocardial infarction (AMI) is a critical condition requiring timely intervention.
- Thrombolytic therapy (TT) is a key treatment for AMI, aiming to restore blood flow.
- Assessing patient eligibility and treatment outcomes for TT is crucial for improving patient care.
Purpose of the Study:
- To determine the eligibility rate of acute myocardial infarction patients for thrombolytic therapy.
- To evaluate the effectiveness and outcomes of thrombolytic therapy in AMI patients.
- To identify factors influencing the utilization and success of thrombolytic therapy.
Main Methods:
- Retrospective analysis of 366 acute myocardial infarction patients treated in 1999.
- Inclusion criteria: age, gender, previous infarction, previous TT, present TT with streptokinase.
- Outcome measures: reperfusion, reocclusion, arrhythmias, heart failure, mortality, pain-to-door time, and door-to-needle time.
Main Results:
- Only 27% of AMI patients received thrombolytic therapy, with lower rates in older patients, women, and those with prior infarction.
- Reperfusion was achieved in 66% of TT patients, with a 14% reocclusion rate and 57% overall success.
- TT was associated with more arrhythmias but less heart failure, and significantly lower mortality (7% vs. 17%) compared to no TT. Late arrival and contraindications were primary reasons for non-treatment.
Conclusions:
- Older age, female gender, prior myocardial infarction, and delayed hospital arrival negatively impact thrombolytic therapy use in AMI.
- Improving TT requires reducing pain-to-door and door-to-needle times, broadening indications, and minimizing contraindications.
- Thrombolytic therapy, when administered appropriately, demonstrates a significant reduction in mortality for acute myocardial infarction patients.
Aim:
To investigate the eligibility of patients with acute myocardial infarction (AMI) for thrombolytic therapy (TT) and evaluate the results of treatment.
Methods:
Retrospective analysis included 366 patients with AMI, mean age 66+/-11 years, treated in 1999. We analyzed age, gender, previous infarction, previous TT, present TT with streptokinase and its effects on the course and outcome, pain-to-door time, and door-to-needle time. Reperfusion and reocclusion were evaluated non-invasively according to the occurrence of the reperfusion and reocclusion syndrome.
Results:
One hundred patients (27%) underwent TT. It was less frequently applied in older patients, women, and patients with previous myocardial infarction. Reperfusion was achieved in 66 (66%) patients and reocclusion occurred in 9 (14%). Final outcome was successful in 57 (57%) patients. The TT group had more frequent arrhythmias (67% vs. 41%, p<0.001) and less frequent heart failure (20% vs. 39%, p<0.001) than the patients without TT. The mortality after TT was significantly lower (7% vs. 17%, p=0.015), without fatal outcome in patients with finally successful TT. Reasons against TT application were late arrival to hospital (51%) and contraindications for TT (34%). In patients without TT, the median pain-to-door time and door-to-needle time were significantly longer than in the TT group (7 vs. 2.5 hours and 55 vs. 20 min, respectively; p<0.001).
Conclusion:
Older age, female gender, previous myocardial infarction, and late arrival to the CCU negatively influence the use of TT in AMI. TT should be improved by shortening pain-to-door time, broadening indications, and limiting contraindications.
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