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Thrombolytic therapy in acute myocardial infarction: Experience at a university hospital in Kuwait
W A Rashed1, S Singh, J N Constandi
1Department of Medicine, Mubarak Al-Kabeer Hospital, and Faculty of Medicine, Kuwait University, Safat, Kuwait.
Insights
Thrombolytic therapy use for acute myocardial infarction (AMI) in Kuwait was high (62%), exceeding European rates. However, underutilization in women and the elderly requires further investigation.
Area of Science:
- Cardiology
- Public Health
Background:
- Thrombolytic therapy significantly reduces mortality and morbidity in acute myocardial infarction (AMI).
- Despite proven benefits, thrombolytic treatment rates remain low (20%-50%) in North America and Europe.
- Data on thrombolytic therapy use in the Arab Middle East is limited.
Purpose of the Study:
- To assess the utilization of thrombolytic therapy in patients with acute myocardial infarction (AMI) at a university hospital in Kuwait.
Main Methods:
- A retrospective analysis was conducted on 343 patients (358 AMI incidents) admitted to Mubarak Al-Kabeer Hospital's coronary care unit between June 1994 and May 1995.
- Patient data included demographics, diagnosis, and treatment received, focusing on thrombolytic therapy administration.
Main Results:
- Kuwaiti patients with AMI were younger (63% <55 years) and had a higher prevalence of diabetes (44%) compared to European cohorts.
- The study observed a high rate of thrombolysis (62%), with a smaller shortfall (8%) compared to European data.
- Key reasons for withholding thrombolysis included non-diagnostic electrocardiograms (ECG); women (38%) and the elderly (>65 years) were significantly less likely to receive thrombolytic therapy.
Conclusions:
- Thrombolytic therapy use in this Kuwaiti university hospital is considered appropriate.
- The underutilization of thrombolytic therapy in women and elderly patients, consistent with other reports, warrants further attention and targeted interventions.
Background:
There is conclusive evidence from large clinical trials that thrombolytic therapy reduces mortality and morbidity in acute myocardial infarction (AMI). However, only a small proportion of patients receive thrombolytic treatment. Estimates have varied from 20%-50% in North America and Europe. Data from the Arab Middle East is sparse. The purpose of our study was to determine the use of thrombolytic therapy in our hospital.
Methods:
We conducted a retrospective analysis of 343 patients (358 incidents of AMI), who were either discharged from or died at the coronary care unit of the Mubarak Al-Kabeer Hospital during the one-year period between June 1994 and May 1995.
Results:
Our patients were relatively younger (63% were 7lt;55 years) and had a much higher prevalence (44%) of diabetes compared to European patients. We observed a high rate (62%) of thrombolysis and a lesser shortfall (8%) when compared to that reported for European patients. The main reason for withholding thrombolytic therapy was non-diagnostic electrocardiogram (ECG) on initial presentation. Women were less likely to be thrombolyzed than men (38% vs. 66%, P=0.0001). Older patients (aged >65 years) were also less likely to be thrombolyzed than younger patients (42% vs. 66%; P=0.0006).
Conclusion:
We conclude that the use of thrombolytic therapy in this university hospital in Kuwait is appropriate. However, as observed in other reports as well, the underutilization of thrombolytic therapy in women and the elderly needs to be addressed in future studies.
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