Related Experiment Videos
Thrombolysis in acute myocardial infarction: an audit of practice
P A Woodmansey1, L D Caldicott, K S Channer
1Department of Cardiology, Royal Hallamshire Hospital, Sheffield.
Insights
Thrombolytic therapy significantly reduced mortality in acute myocardial infarction patients, including those over 75. This treatment was generally safe and appropriate, with potential for wider application.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality.
- Thrombolytic therapy is a critical treatment for AMI.
- Evaluating the real-world use and outcomes of thrombolysis is essential.
Purpose of the Study:
- To audit the use of thrombolysis in patients with acute myocardial infarction.
- To assess the impact of thrombolysis on inpatient mortality.
- To evaluate the safety and appropriateness of thrombolytic therapy.
Main Methods:
- Retrospective casenote audit of 212 out of 335 AMI patients.
- Conducted on a coronary care unit in a Sheffield teaching hospital.
- Analysis of patient demographics, treatment received, and outcomes.
Main Results:
- Overall inpatient mortality was 17%, with 12% in the thrombolysis group versus 26% in the control group (p < 0.005).
- Patients aged 75 years or older showed reduced mortality with thrombolytics (p < 0.05).
- Streptokinase infusion was stopped in 4% due to adverse events; therapy was generally safe and appropriate.
Conclusions:
- Thrombolysis demonstrated clear mortality benefits for all AMI patients, including the elderly.
- High rates of safe and appropriate thrombolysis use were observed.
- Potential exists to refine guidelines for broader thrombolytic therapy application.
Abstract:
A retrospective casenote audit of the use of thrombolysis in 212 of 335 patients with acute myocardial infarction (63%) was carried out on the coronary care unit of a Sheffield teaching hospital. The overall inpatient mortality was 17%, 12% in the thrombolysis group and 26% in the remainder (p < 0.005). Patients aged 75 years or older were less likely to die if they received thrombolytics (p < 0.05) despite an excess of anterior myocardial infarctions in the thrombolysis group (p < 0.01). The infusion of streptokinase had to be stopped in five patients (4%) because of allergy or arrhythmias. Thrombolytic therapy was considered in all patients with acute myocardial infarction; it was withheld inappropriately in eight cases and given inappropriately in two. Thrombolysis produced clear benefits in mortality for all patients, including those over 75 years old. There was a high rate of use of thrombolysis which was generally safe and appropriate, although adjustments to the guidelines may allow even more patients to receive this therapy.