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[Use of thrombolysis for myocardial infarction in Israel]
1Neufeld Cardiac Research Institute, Chaim Sheba Medical Center, Tel Hashomer.
Insights
Thrombolysis, a key treatment for acute myocardial infarction, was given to 35% of patients in Israel in 1990. Late arrival and lack of ST elevation were main reasons for exclusion.
Area of Science:
- Cardiology
- Public Health
Background:
- Thrombolysis is a standard initial treatment for acute myocardial infarction (AMI).
- Understanding the implementation and barriers to thrombolytic therapy in specific healthcare settings is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the utilization rates of thrombolysis for AMI in Israel.
- To identify the primary reasons for excluding patients from thrombolytic therapy.
- To compare hospital mortality between patients who received thrombolysis and those who did not.
Main Methods:
- Prospective study of 413 consecutive patients with AMI admitted to 18 coronary care units in Israel during January 1990.
- Data collected on patient demographics, infarction characteristics, treatment administration, and reasons for exclusion.
- Comparison of hospital mortality rates between treatment groups.
Main Results:
- Thrombolytic therapy was administered to 35% of patients (145/413).
- Therapy was more frequently used in younger patients (<75 years) and those with first or anterior infarctions.
- Key reasons for exclusion included late arrival (33%) and absence of ST elevation on ECG (28%).
- Hospital mortality was 6% in the thrombolytic group versus 20% in the non-thrombolytic group (significance unclear due to lack of randomization).
Conclusions:
- Thrombolysis implementation for AMI in Israel in 1990 was suboptimal, with significant patient and logistical barriers.
- Late patient presentation and diagnostic criteria (absence of ST elevation) were major impediments to therapy.
- Further research is needed to clarify the mortality benefit in a randomized setting.
Abstract:
Thrombolysis is generally accepted as the initial treatment for acute myocardial infarction. The extent to which this therapy is being implemented in Israel and the reasons for exclusion of cases from thrombolytic therapy were prospectively investigated. 413 consecutive patients with acute myocardial infarction hospitalized during January 1990 in 18 of Israel's 25 coronary care units were studied. Thrombolytic therapy was administered to 145 patients (35%: 38% of the men and 29% of the women; NS). It was used more often in those up to the age of 75 (38%) than in those over (18%, p less than 0.005) and in those with a first or anterior infarction (40% and 48%, respectively) than those with recurrent or inferior infarction (23% and 31%, respectively; p less than 0.005 for both). The 2 most frequent reasons for not using thrombolysis were late arrival in the coronary care unit (33%) and absence of ST elevation on the admission electrocardiogram (28%). Hospital mortality was 6% in the thrombolytic group versus 20% in those ineligible for thrombolysis. The significance of this difference is not clear as there was no randomization to treatment.