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[Thrombolytic therapy in acute myocardial infarct--is it being used to the fullest?]
B Carôla1, L Calçada-Correia, P G Pedro
1Unidade de Cuidados Intensivos e Monitorização/Serviço de Medicina IV, Hospital Universitário de Santa Maria, Lisboa.
Insights
Thrombolytic therapy (TT) was given to only 30% of acute myocardial infarction (AMI) patients. Those not receiving TT often lacked ECG criteria or were outside the treatment window, indicating a need for new strategies.
Area of Science:
- Cardiology
- Internal Medicine
- Emergency Medicine
Background:
- Acute myocardial infarction (AMI) is a leading cause of mortality worldwide.
- Thrombolytic therapy (TT) is a critical treatment for AMI, aiming to restore blood flow.
- Understanding patterns of TT utilization is essential for improving patient outcomes.
Purpose of the Study:
- To evaluate the clinical experience and utilization of thrombolytic therapy (TT) in patients diagnosed with acute myocardial infarction (AMI).
- To identify patient characteristics and clinical factors influencing the administration of TT.
- To assess the impact of TT on hospital mortality in AMI patients.
Main Methods:
- Retrospective analysis of clinical records of 1319 patients diagnosed with AMI between May 1988 and December 1995.
- Data collected from the Intensive Cardiac Care Unit of Santa Maria University Hospital, Lisbon, Portugal.
- Evaluation of patient demographics, clinical presentation, ECG findings, and treatment outcomes.
Main Results:
- Thrombolytic therapy (TT) was administered to 30% of AMI patients.
- Female patients and those with Killip class III-IV heart failure received TT less frequently.
- Patients receiving TT had significantly lower hospital mortality (9.4%) compared to those excluded (18.2%).
- Major reasons for excluding patients from TT included presentation >12 hours after pain onset or lack of ST-segment elevation/LBBB on ECG.
Conclusions:
- The utilization rate of TT for AMI remains suboptimal, with only 30% of eligible patients receiving treatment.
- A significant proportion of excluded patients (75%) lacked appropriate ECG criteria or fell outside the standard therapeutic time window.
- Development of novel diagnostic and intervention strategies is crucial for improving treatment rates and outcomes in this patient subgroup.
Objective:
To evaluate the experience with thrombolytic therapy (TT) in the treatment of patients with the discharge diagnosis of acute myocardial infarction (AMI).
Design:
Retrospective analysis of the clinical records of patients with the discharge diagnosis of AMI, between May 1988 and December 1995.
Setting:
Intensive Cardiac Care Unit (UCIM-Medicina IV) of Santa Maria University Hospital, Lisbon, Portugal.
Patients:
1319 patients, 958 men (73%) and 361 women, mean age 64 +/- 12 years.
Main Results:
Thrombolytic therapy was administered in 391 patients (30%). Female patients received less thrombolytic therapy compared with male (17% vs. 34%; p < 0.001). Anterior wall infarction was more frequent (38%). Patients in Killip class I-II (77%) received more thrombolytic therapy than class III-IV (33% vs. 17%). The utilization rate of thrombolytic therapy increased from 25% in 1988 to 34% in 1995. Two major categories of patients were not treated with thrombolysis: 1) patients presented more than 12 hours after pain onset (38%); 2) patients without ST segment elevation or LBBB on the ECG presented (37%). Overall hospital mortality was 15.6%. The mortality in patients receiving thrombolytic therapy was significantly lower than in those excluded (9.4% vs. 18.2%; p < 0.001).
Conclusion:
Only 30% of patients with AMI receive TT. Of those excluded from this important therapeutic intervention, 75% had no ECG criteria or were outside the standard therapeutic "window". This significant group of patients need new diagnostic and intervention strategies.