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[Fibrinolysis in a regional hospital]
R T Anderhalden1, H U Tschanz, R Streuli
1Medizinische Klinik, Regionalspital Langenthal.
Insights
Streptokinase fibrinolytic therapy is safe and effective for acute myocardial infarction patients in regional hospitals. This treatment, administered promptly, shows positive outcomes and can be easily performed, improving patient care.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Acute myocardial infarction (AMI) management.
- Regional hospital setting for treatment delivery.
Purpose:
- To evaluate the safety and effectiveness of intravenous streptokinase in AMI patients.
- To assess treatment outcomes and feasibility in a community hospital.
Summary:
- 116 AMI patients were studied; 27 received streptokinase. Peak CPK within 6 hours was observed in 44% of treated patients admitted within 4 hours of chest pain.
- Arrhythmias requiring treatment occurred in 67% of fibrinolyzed patients. Lysis was not possible in only 4.5% due to late hospital admission.
- Mortality was 11.2% overall, with only 1 death in the streptokinase group versus 12 in the untreated group.
Impact:
- Streptokinase is a viable and effective fibrinolytic option for AMI in regional hospitals.
- Demonstrates successful implementation of advanced cardiac care in non-specialized centers.
Abstract:
From January 1, 1989 to September 30, 1990, 116 patients with acute myocardial infarction were hospitalized at the regional hospital of Langenthal. Of those 116 patients, 27 (23%) were treated with intravenous streptokinase; in 12 of them (44%) CPK reached its peak within 6 hours after starting lysis; all were admitted within 4 hours after the beginning of chest pain. Of the fibrinolyzed patients, 18 (67%) had arrhythmias which needed to be treated. In 10 of these 18 patients CPK reached its peak within 6 hours. Of the 89 patients not treated with streptokinase, 27 (30%) did not fulfill the entry criteria of the protocol, 16 (18%) had exclusion criteria, and 46 (52%) had exclusion criteria as well as absent inclusion criteria. In only 4 patients (4.5%) was lysis not possible because they entered hospital later than 6 hours after the beginning of pain, and 8 patients (9%) exceeded the upper age limit of 70 years. Of the 116 patients, 13 (11.2%) died; 12 were not treated with streptokinase. Our study shows that fibrinolytic treatment with streptokinase is a safe and effective therapy for patients with acute myocardial infarction and can easily be performed in a regional hospital.