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Frequency of use of thrombolytic therapy in acute myocardial infarction in Israel
1Neufeld Cardiac Research Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Insights
Thrombolytic therapy for acute myocardial infarction (AMI) was given to 35% of patients. Late arrival and lack of ST elevation were key exclusion reasons, impacting hospital mortality.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Thrombolysis is a standard initial treatment for acute myocardial infarction (AMI).
- Implementation and exclusion criteria for thrombolysis in daily practice require investigation.
Purpose of the Study:
- To assess the utilization of thrombolytic therapy in patients with AMI.
- To identify reasons for excluding patients from thrombolysis.
- To compare hospital mortality between treated and untreated patients.
Main Methods:
- Prospective survey of 413 consecutive AMI patients across 18 coronary care units in Israel.
- Data collection on thrombolytic therapy administration, patient demographics, AMI characteristics, and exclusion reasons.
- Comparison of hospital mortality rates.
Main Results:
- Thrombolytic therapy was administered to 145 patients (35%).
- Therapy was more frequent in younger patients (<75 years) and those with first or anterior AMI.
- Late arrival (33%) and lack of ST elevation (28%) were primary exclusion reasons.
- Hospital mortality was 6% in the thrombolytic group versus 20% in the ineligible group.
Conclusions:
- Thrombolysis for AMI is underutilized in some settings, with specific patient groups and logistical factors influencing its administration.
- Late arrival and ECG findings are significant barriers to thrombolytic therapy.
- A notable difference in hospital mortality exists between patients receiving and not receiving thrombolysis, though causality requires further study.
Abstract:
Thrombolysis is now generally accepted as the initial treatment for patients with acute myocardial infarction (AMI). The extent to which this therapy is implemented in daily practice and the reasons for exclusion from thrombolytic therapy among 413 consecutive patients with AMI hospitalized in 18 coronary care units in Israel during a 1-month survey were prospectively investigated. Thrombolytic therapy administered to 145 patients (35%) was given to 38% of men versus 29% of women (p = not significant), to 38% of patients less than 75 years old compared with 18% of the very elderly (p less than 0.005), and more often to patients with a first or anterior AMI (40 and 48%) than to counterparts with recurrent or inferior AMI (23 and 31%, respectively, p less than 0.005 for both). The 2 most frequent reasons for excluding patients from thrombolysis were late arrivals to coronary care units (33%) and lack of ST elevation on the admission electrocardiogram (28%). Hospital mortality was 6% in the thrombolytic group versus 20% in patients found ineligible for thrombolysis. The significance of this difference is not clear as treatment was not randomized.