Audit of acute myocardial infarctions at Saint James's Hospital, Dublin, from 1996 to 1999
1Department of Cardiology, CResT Directorate, Saint James' Hospital, Dublin 8.
Insights
This study audited acute transmural myocardial infarctions, finding revascularization therapy increased significantly. However, case fatality rates remain high, indicating a need for improved treatment timeliness and adherence to evidence-based guidelines for heart attack patients.
Area of Science:
- Cardiology
- Clinical Auditing
- Public Health
Background:
- Tertiary referral hospitals manage complex cardiac cases.
- Acute transmural myocardial infarction (ATMI) represents a significant cardiology admission.
- Previous audits highlight evolving treatment landscapes.
Purpose of the Study:
- To audit acute transmural myocardial infarction (ATMI) cases from 1996-1999.
- To evaluate revascularization therapy rates and outcomes.
- To assess adherence to evidence-based medical management.
Main Methods:
- Retrospective audit of 178 annual ATMI patients.
- Analysis of treatment modalities: thrombolysis and primary angioplasty.
- Review of medication prescription patterns (aspirin, warfarin, beta-blockers, ACE inhibitors, statins).
Main Results:
- Revascularization therapy increased to 72% (thrombolysis 67%, angioplasty 5%), up from 35% in 1992.
- Late presentation (15%) was the primary barrier to thrombolysis.
- Case fatality rate was 16%, higher than clinical trial data.
- High prescription rates for aspirin/warfarin (99%) and beta-blockers (67%).
- Lower-than-expected use of ACE inhibitors (34%) and statins (28%).
Conclusions:
- Significant improvement in revascularization rates for ATMI.
- Late presentation remains a critical challenge.
- Case fatality highlights the gap between clinical practice and trial results.
- Further optimization of guideline-directed medical therapy is warranted for heart attack patients.
Abstract:
Saint James' Hospital is a 650-bed tertiary referral hospital. An audit was performed of acute transmural myocardial infarctions for the years 1996 to 1999 inclusive. On average there were 2043 cardiology admissions annually, 9.8% of all hospital admissions. Acute transmural myocardial infarction was diagnosed in 178 patients annually, and was less common during the summer. The figure of 72% receiving revascularisation therapy (thrombolysis 67%, primary angioplasty 5%) compares favourably with 35% in 1992. The main reason for not receiving thrombolysis was late presentation (15%) with contraindications present in only 5%. The case fatality rate was 16% confirming the higher mortality in clinical practice than that of thrombolytic trials. The prescription of aspirin or warfarin (99%) and betablockers (67%) was in line with international trials. The use of angiotensin converting enzyme inhibitors (34%) and statins (28%) is similar to other studies but less than would be expected according to trial evidence.
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