Thrombolytic therapy in acute myocardial infarction: practice pattern at an Arab Middle Eastern centre

We studied the use of thrombolytic treatment at a major hospital in Kuwait. There were three aims to our study. First, to document the rates of use and shortfall of thrombolytic therapy. Secondly, to identify the reasons for the shortfall. Thirdly, to study the influence of age and gender on the shortfall.

We retrospectively examined the use of thrombolytic treatment in 983 consecutive patients with the diagnosis of acute myocardial infarction (AMI) during a three-year period, from June 1994 to May 1997. The term "shortfall" refers to the number of patients who were eligible for thrombolytic treatment but did not receive it. Patients were relatively young (59% were < 55 years old). There was a high prevalence of diabetes (39%). We identified 669 patients who were eligible to receive thrombolytic therapy (68% of the total AMI population). Of the eligible population, 625 patients (93.4%) received thrombolytic therapy while 44 patients did not (a shortfall of 6.6% among the eligible population). The reasons for the shortfall were: unknown reasons, retinopathy, and others. The shortfall was higher in women than in men (13% vs. 6%, respectively; p=0.02). The shortfall was higher in older patients than in younger patients (18% vs. 5%, respectively; p=0.0002).

Our thrombolysis rate is one of the highest, and the shortfall is one of the lowest reported rates in the literature. Many eligible women and older patients are not receiving thrombolytic therapy. Changes to thrombolytic therapy use should be implemented to avoid unnecessary shortfall and potential gender and age bias.